Individual
JESSICA KRUEGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
4825 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1365
(304) 346-9667
Mailing address
5524 E VIA MONTOYA DR, PHOENIX, AZ 85054-7147
(951) 505-9295
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C2473
WV
Other
Enumeration date
01/11/2024
Last updated
01/11/2024
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