Provider Demographics
NPI:1902922032
Name:KRIEGBAUM, ROBERT (OT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KRIEGBAUM
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 SE GREENVILLE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394-9465
Mailing Address - Country:US
Mailing Address - Phone:765-584-0542
Mailing Address - Fax:765-584-0766
Practice Address - Street 1:409 SE GREENVILLE AVE STE 200
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-9465
Practice Address - Country:US
Practice Address - Phone:765-584-0542
Practice Address - Fax:765-584-0766
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003450A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist