Provider Demographics
NPI:1073843918
Name:KRUEGER, RHONDA WALLACE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:WALLACE
Last Name:KRUEGER
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 1:4513 CINDIWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4744
Mailing Address - Country:US
Mailing Address - Phone:804-745-3916
Mailing Address - Fax:
Practice Address - Street 1:4513 CINDIWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-4744
Practice Address - Country:US
Practice Address - Phone:804-745-3916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-27
Last Update Date:2009-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000131224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant