Provider Demographics
NPI:1083995153
Name:QUAKE-RAPP, CYNTHIA (OTR)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:QUAKE-RAPP
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 SAINT JAMES CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2178
Mailing Address - Country:US
Mailing Address - Phone:502-873-4217
Mailing Address - Fax:502-585-7149
Practice Address - Street 1:845 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2213
Practice Address - Country:US
Practice Address - Phone:502-873-4217
Practice Address - Fax:502-585-7149
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103879225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist