Provider Demographics
NPI:1780364539
Name:SCKRABULIS, KELYN RAE (OTD, OTRL)
Entity type:Individual
Prefix:
First Name:KELYN
Middle Name:RAE
Last Name:SCKRABULIS
Suffix:
Gender:F
Credentials:OTD, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E LASALLE AVE APT 308C
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-3711
Mailing Address - Country:US
Mailing Address - Phone:616-633-2277
Mailing Address - Fax:
Practice Address - Street 1:1415 LINCOLNWAY W STE M
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-2061
Practice Address - Country:US
Practice Address - Phone:574-675-7767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31008109A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist