Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 451974 | OR |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 451974 | OR |
NPI | 1386000461 |
---|---|
Provider Name | George Herbert Krueger |
First Address | Wilsonville, OR 97070-9697 |
Second Address | Salem, OR 97317-9336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2016 |
Last Update Date | 06/01/2016 |