Provider Demographics
NPI:1811922271
Name:KRUEGER, ANN (OT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:KRUEGER
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 1:103 S PIONEER RD # 100
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3871
Mailing Address - Country:US
Mailing Address - Phone:920-922-7776
Mailing Address - Fax:920-922-2938
Practice Address - Street 1:103 S PIONEER RD # 100
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3871
Practice Address - Country:US
Practice Address - Phone:920-922-7776
Practice Address - Fax:920-922-2938
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI169-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40778900Medicaid
WIS98238Medicare UPIN