Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT.008940 | OH |
NPI | 1003201054 |
---|---|
Provider Name | Nicole Kruse |
First Address | Columbus Grove, OH 45830-1224 |
Second Address | Maumee, OH 43537-9691 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2015 |
Last Update Date | 06/04/2015 |