Provider Demographics
NPI:1316300544
Name:KRAUS, KARA
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:KRAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1440
Mailing Address - Street 2:
Mailing Address - City:DOLORES
Mailing Address - State:CO
Mailing Address - Zip Code:81323-1440
Mailing Address - Country:US
Mailing Address - Phone:812-480-7917
Mailing Address - Fax:
Practice Address - Street 1:812 CENTRAL AVE.
Practice Address - Street 2:APT. #5
Practice Address - City:DOLORES
Practice Address - State:CO
Practice Address - Zip Code:81323
Practice Address - Country:US
Practice Address - Phone:812-480-7917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000315982255A2300X
IN390200000X
COAT.00018942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program