Ellison M. Kruckenberg, COTA/L
NPI 1386100402ActiveIndividual· Occupational Therapy Assistant· Bountiful, UT
Occupational Therapy Assistant (COTA/L) in Bountiful, Utah, licensed in UT, with an NPI issued in February 2019.
Overview
| NPI | 1386100402 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | COTA/L |
| Sole proprietor | Yes |
| NPI issued | Feb 13, 2019 |
| Last updated in NPPES | Jul 12, 2022 |
| Certified by provider | Jul 12, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Occupational Therapy Assistant Primary | 224Z00000X | 12931092-4202 | UT |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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