Provider Demographics
NPI:1831859560
Name:CRUMPACKER, ADDISON (OTR/L)
Entity type:Individual
Prefix:
First Name:ADDISON
Middle Name:
Last Name:CRUMPACKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ADDISON
Other - Middle Name:
Other - Last Name:TORCHIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 W QUAIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:KS
Mailing Address - Zip Code:66725-9302
Mailing Address - Country:US
Mailing Address - Phone:620-762-3980
Mailing Address - Fax:
Practice Address - Street 1:1 MT CARMEL WAY
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-7587
Practice Address - Country:US
Practice Address - Phone:620-231-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03610225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist