Healthcare Provider Details

I. General information

NPI: 1043092034
Provider Name (Legal Business Name): SYDNEY KRUEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16835 DEER CREEK DR STE 120
SPRING TX
77379-5803
US

IV. Provider business mailing address

24002 LEMMON ARBOR DR
SPRING TX
77389-1507
US

V. Phone/Fax

Practice location:
  • Phone: 281-379-4373
  • Fax:
Mailing address:
  • Phone: 210-872-2901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number124112
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: