Provider Demographics
NPI:1750704656
Name:KREUZER, AMANDA KAY (COTA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KAY
Last Name:KREUZER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KAY
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:3109 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144
Mailing Address - Country:US
Mailing Address - Phone:262-764-4225
Mailing Address - Fax:262-764-4296
Practice Address - Street 1:3109 30TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144
Practice Address - Country:US
Practice Address - Phone:262-764-4225
Practice Address - Fax:262-764-4296
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4663-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant