Provider Demographics
NPI:1891095279
Name:KRUG, JESSICA (OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KRUG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SHOEMAKER CIR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-4102
Mailing Address - Country:US
Mailing Address - Phone:870-612-2578
Mailing Address - Fax:
Practice Address - Street 1:10920 HEBER SPRINGS RD N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:AR
Practice Address - Zip Code:72523-9412
Practice Address - Country:US
Practice Address - Phone:870-668-3844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2380225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist