MEDICARE: DR. REBECCA L. KRUKEMYER AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	A-00967	OH

General Provider Information

NPI Number	:	1780656082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA L. KRUKEMYER AU.D.

Provider Business Mailing Address
First Line	:	133 E. FRONT ST. #687
Second Line	:	PO BOX 687
City	:	PEMBERVILLE
State	:	OH
Zip	:	43450-0687
Country	:	US
Telephone Number	:	419-287-2201
Fax Number	:	419-287-2202

Provider Business Practice Location Address
First Line	:	133 EAST FRONT ST.
Second Line	:
City	:	PEMBERVILLE
State	:	OH
Zip	:	43450
Country	:	US
Telephone Number	:	419-287-2201
Fax Number	:	419-287-2202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	04/29/2008

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