Provider Demographics
NPI:1780677468
Name:KRAUS, JILL (OT)
Entity type:Individual
Prefix:MISS
First Name:JILL
Middle Name:
Last Name:KRAUS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 W PEORIA AVE
Mailing Address - Street 2:SUITE 224
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4614
Mailing Address - Country:US
Mailing Address - Phone:602-866-2231
Mailing Address - Fax:602-866-2261
Practice Address - Street 1:3233 W PEORIA AVE
Practice Address - Street 2:SUITE 224
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4614
Practice Address - Country:US
Practice Address - Phone:602-866-2231
Practice Address - Fax:602-866-2261
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3228174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ501032Medicaid
AZAZ0310170OtherBCBS
AZ893851OtherAHCCCS