Provider Demographics
NPI:1902443716
Name:KRAUS, ELISABETH ANNE
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ANNE
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 1:4546 WINKLER AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-7028
Mailing Address - Country:US
Mailing Address - Phone:217-357-4904
Mailing Address - Fax:
Practice Address - Street 1:3501 HANCOCK BRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-7126
Practice Address - Country:US
Practice Address - Phone:217-357-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-30
Last Update Date:2019-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18177225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist