Provider Demographics
NPI:1376128744
Name:KEPNER, GARRETT MATTHEW (OTR/L)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:MATTHEW
Last Name:KEPNER
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 VALLEY GREEN DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-6779
Mailing Address - Country:US
Mailing Address - Phone:570-204-4137
Mailing Address - Fax:
Practice Address - Street 1:867 YORK RD
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7501
Practice Address - Country:US
Practice Address - Phone:717-337-3238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017552225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist