Individual
TAYLOR BLAKE CRUPPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
904 LEE BLVD, UNIT 106, LEHIGH ACRES, FL 33936-4953
(239) 674-9374
(239) 491-3057
Mailing address
904 LEE BLVD, UNIT 106, LEHIGH ACRES, FL 33936-4953
(239) 674-9374
(239) 491-3057
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA14752
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006236000
OFFICE MEDICAID #
FL
Enumeration date
02/26/2016
Last updated
02/26/2016
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