Provider Demographics
NPI:1982990834
Name:KRUSE, SUMMER (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:
Last Name:KRUSE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1215
Mailing Address - Country:US
Mailing Address - Phone:419-884-7447
Mailing Address - Fax:
Practice Address - Street 1:250 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-1215
Practice Address - Country:US
Practice Address - Phone:419-884-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7417225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist