Healthcare Provider Details

I. General information

NPI: 1235779414
Provider Name (Legal Business Name): ANNA KUEGLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W TAMARACK RD
ALTUS OK
73521-1599
US

IV. Provider business mailing address

401 W TAMARACK RD
ALTUS OK
73521-1599
US

V. Phone/Fax

Practice location:
  • Phone: 580-482-7308
  • Fax:
Mailing address:
  • Phone: 580-482-7308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5806
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: