Provider Demographics
NPI:1891764148
Name:KRAUSE, MICHELLE LEA (PT/ATC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LEA
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:PT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 E MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5525
Mailing Address - Country:US
Mailing Address - Phone:405-425-1960
Mailing Address - Fax:405-425-1962
Practice Address - Street 1:2501 E MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5525
Practice Address - Country:US
Practice Address - Phone:405-425-1960
Practice Address - Fax:405-425-1962
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2813208100000X
OK3712081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine