Provider Demographics
NPI:1669860037
Name:CRAMBLETT, KELLY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:CRAMBLETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 ROYAL WOODS DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8661
Mailing Address - Country:US
Mailing Address - Phone:330-714-1179
Mailing Address - Fax:
Practice Address - Street 1:120 BROOKMONT RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-3057
Practice Address - Country:US
Practice Address - Phone:330-666-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3135225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant