Provider Demographics
NPI:1255663100
Name:KRUGER, KRISTY A (OT)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:A
Last Name:KRUGER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:A
Other - Last Name:SCHERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:7300 E INDIANA ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2794
Mailing Address - Country:US
Mailing Address - Phone:812-476-0409
Mailing Address - Fax:812-476-1016
Practice Address - Street 1:2121 WILLOW ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-5355
Practice Address - Country:US
Practice Address - Phone:812-882-1141
Practice Address - Fax:812-255-0045
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004755A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000702810OtherBLUE CROSS BLUE SHIELD
IN200976770Medicaid
IN000000702810OtherBLUE CROSS BLUE SHIELD
IN200976770Medicaid
IN198850QMedicare PIN