Individual
MRS. MARY T KRUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
1126 S 70TH ST, SUITE S305B, WEST ALLIS, WI 53214-3151
(414) 456-2330
Mailing address
2433 N 117TH ST, WAUWATOSA, WI 53226-1119
(414) 476-4165
Taxonomy
Speciality
Code
Description
License number
State
225XN1300X
Neurorehabilitation Occupational Therapist
Primary
1003-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003-026
STATE OF WISCONSIN OT LICENSE
WI
Enumeration date
05/31/2008
Last updated
05/31/2008
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