Provider Demographics
NPI:1518034644
Name:CROOKS, RAELENA LEE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:RAELENA
Middle Name:LEE
Last Name:CROOKS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:RAELENA
Other - Middle Name:LEE
Other - Last Name:GOURLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:141 HIDDEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-9546
Mailing Address - Country:US
Mailing Address - Phone:714-401-1996
Mailing Address - Fax:
Practice Address - Street 1:1201 W CENTER ST
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-3103
Practice Address - Country:US
Practice Address - Phone:318-483-5037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8159225X00000X
AROTR3290225X00000X
LA200579225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist