Provider Demographics
NPI:1700393501
Name:CRUPPER, KELLY ANNE (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:CRUPPER
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 TEAL CT
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7346
Mailing Address - Country:US
Mailing Address - Phone:502-710-1812
Mailing Address - Fax:
Practice Address - Street 1:4603 TIMBERWALK CT
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-6746
Practice Address - Country:US
Practice Address - Phone:703-864-6695
Practice Address - Fax:888-830-3233
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175140225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist