Provider Demographics
NPI:1457501454
Name:KRUG, MAURA
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:KRUG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 SAINT ANDREWS PL
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4625
Mailing Address - Country:US
Mailing Address - Phone:407-312-1317
Mailing Address - Fax:
Practice Address - Street 1:1924 SAINT ANDREWS PL
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4625
Practice Address - Country:US
Practice Address - Phone:407-312-1317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist