Provider Demographics
NPI:1043506868
Name:CRUMPLER, LAURA (OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CRUMPLER
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 LAKE LAUREL RD NE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-8443
Mailing Address - Country:US
Mailing Address - Phone:478-804-0077
Mailing Address - Fax:
Practice Address - Street 1:107 SPORTSMAN CLUB RD NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-8787
Practice Address - Country:US
Practice Address - Phone:478-453-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004029225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist