Provider Demographics
NPI:1679735526
Name:CROSON, DEANNA MARIE (COTA)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:CROSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S RUTLAND ST
Mailing Address - Street 2:
Mailing Address - City:BOOKLYN
Mailing Address - State:WI
Mailing Address - Zip Code:53521
Mailing Address - Country:US
Mailing Address - Phone:608-225-8344
Mailing Address - Fax:
Practice Address - Street 1:208 S RUTLAND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:WI
Practice Address - Zip Code:53521-9503
Practice Address - Country:US
Practice Address - Phone:608-225-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10020027OtherOCCUPATIONAL THERAPY ASSISTANT LICENSE
CA1730OtherCOTA LICENSE CERTIFICATE
WI993744OtherNBCOT CRTIFICATION