Individual
JORDAN ASHLEY KRUSBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1715 MARTIN DR, WEATHERFORD, TX 76086-6738
(817) 458-3100
Mailing address
9932 HENNA LN, FT WORTH, TX 76108-6502
(615) 946-6475
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
214853
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
N/A
—
Enumeration date
09/12/2018
Last updated
09/12/2018
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