Provider Demographics
NPI:1144629056
Name:TROSKE, JUSTINE ERIN (MSOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:ERIN
Last Name:TROSKE
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:MS
Other - First Name:JUSTINE
Other - Middle Name:ERIN
Other - Last Name:TROSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOT, OTR/L
Mailing Address - Street 1:680 N HOLT AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-1492
Mailing Address - Country:US
Mailing Address - Phone:636-212-0764
Mailing Address - Fax:
Practice Address - Street 1:1500 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-3011
Practice Address - Country:US
Practice Address - Phone:417-328-6515
Practice Address - Fax:417-328-6716
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014004167225XP0200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics