Provider Demographics
NPI:1518668409
Name:TEPEL, CARLY (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:TEPEL
Suffix:
Gender:F
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 1:2335 E SAUNDERS ST # 3
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5434
Mailing Address - Country:US
Mailing Address - Phone:956-791-4800
Mailing Address - Fax:
Practice Address - Street 1:928 JAYMOR RD
Practice Address - Street 2:C-150
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3832
Practice Address - Country:US
Practice Address - Phone:215-330-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124055225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist