Provider Demographics
NPI:1134160690
Name:KRUEGER, ROBERT BRUCE (OT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRUCE
Last Name:KRUEGER
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:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:NESKOWIN
Mailing Address - State:OR
Mailing Address - Zip Code:97149-0834
Mailing Address - Country:US
Mailing Address - Phone:503-392-6187
Mailing Address - Fax:503-392-5858
Practice Address - Street 1:44305 AEOLIAN WAY
Practice Address - Street 2:
Practice Address - City:NESKOWIN
Practice Address - State:OR
Practice Address - Zip Code:97149-9737
Practice Address - Country:US
Practice Address - Phone:503-392-4085
Practice Address - Fax:503-392-5858
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5329225X00000X, 225XE1200X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR231984Medicaid
OR134581Medicare PIN