Provider Demographics
NPI:1568588267
Name:KRUG, KARRA MARIE (MSOTR/L)
Entity Type:Individual
Prefix:MS
First Name:KARRA
Middle Name:MARIE
Last Name:KRUG
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:KARRA
Other - Middle Name:
Other - Last Name:PANTALONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR/L
Mailing Address - Street 1:2929 W SILVER FOX WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85045-2263
Mailing Address - Country:US
Mailing Address - Phone:860-334-8176
Mailing Address - Fax:
Practice Address - Street 1:8700 S KYRENE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2197
Practice Address - Country:US
Practice Address - Phone:480-541-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01137225X00000X
AZOTH-005958225X00000X
MD05871225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist