Healthcare Provider Details

I. General information

NPI: 1720855950
Provider Name (Legal Business Name): CARLEY KRUGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 HARBOR DR STE 112
SAUSALITO CA
94965-2845
US

IV. Provider business mailing address

2120 JONES ST APT 3
SAN FRANCISCO CA
94133-2531
US

V. Phone/Fax

Practice location:
  • Phone: 415-339-8800
  • Fax: 415-963-4243
Mailing address:
  • Phone: 925-786-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number24898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: