MEDICARE: VANESSA CATHERINE KRUGER OTR/L

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	225XP0200X	Pediatric Occupational Therapist	123338	TX
2	225XP0200X	Pediatric Occupational Therapist	016079-1	NY

General Provider Information

NPI Number	:	1881902484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA CATHERINE KRUGER OTR/L

Provider Business Mailing Address
First Line	:	PO BOX 1826
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-8160
Country	:	US
Telephone Number	:	646-420-0177
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 E 19TH ST STE 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-2888
Country	:	US
Telephone Number	:	212-721-5220
Fax Number	:

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

Provider Enumeration Date	:	09/16/2010
Last Update Date	:	02/13/2023

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