Provider Demographics
NPI:1285397406
Name:KRUGER, MARIA (COTA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KRUGER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42490 GARFIELD RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4200
Mailing Address - Country:US
Mailing Address - Phone:586-563-4214
Mailing Address - Fax:586-884-0695
Practice Address - Street 1:18186 FLEUR DE LIS
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1280
Practice Address - Country:US
Practice Address - Phone:586-879-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist