Provider Demographics
NPI:1033448980
Name:KEPLINGER, PATRICIA (COTA)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:
Last Name:KEPLINGER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 MONARCH DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7455
Mailing Address - Country:US
Mailing Address - Phone:260-493-6143
Mailing Address - Fax:
Practice Address - Street 1:2940 NORTH CLINTON STREET
Practice Address - Street 2:5405 MONARCH DR.
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-7455
Practice Address - Country:US
Practice Address - Phone:260-484-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001394A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant