Provider Demographics
NPI:1568600161
Name:KRUEGER, ALISHIA ELIZABETH MAE (OTR)
Entity Type:Individual
Prefix:
First Name:ALISHIA
Middle Name:ELIZABETH MAE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ALISHIA
Other - Middle Name:ELIZABETH MAE
Other - Last Name:LEASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1830 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-2552
Mailing Address - Country:US
Mailing Address - Phone:920-982-2719
Mailing Address - Fax:
Practice Address - Street 1:1830 NASSAU ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-2552
Practice Address - Country:US
Practice Address - Phone:920-359-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41049900224Z00000X
WI6908-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41049900Medicaid