Provider Demographics
NPI:1083018154
Name:KRIEGER, JACOB ANTHONY
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ANTHONY
Last Name:KRIEGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 COUNTY ROAD 34
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-4110
Mailing Address - Country:US
Mailing Address - Phone:256-263-7821
Mailing Address - Fax:
Practice Address - Street 1:211 ANA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1768
Practice Address - Country:US
Practice Address - Phone:256-766-8963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2808224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant