Provider Demographics
NPI:1699774943
Name:KRUEGER, PATRICIA ANN (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12911 120TH AVE NE STE H220
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3064
Mailing Address - Country:US
Mailing Address - Phone:425-823-4224
Mailing Address - Fax:425-820-8975
Practice Address - Street 1:12911 120TH AVE NE STE H220
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3064
Practice Address - Country:US
Practice Address - Phone:425-823-4224
Practice Address - Fax:425-820-8975
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002596225X00000X
WAOT00002595225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1016627Medicaid
WA8405235Medicaid
WA188719OtherLABOR AND INDUSTRIES