Taylor Blake Crupper

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA14752 Issued in FL

Practice address

904 Lee Blvd
Unit 106
Lehigh Acres, FL 33936-4953

Phone

(239) 674-9374

Fax

(239) 491-3057

NPI assigned

Feb 26, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wee Playtherapy PLLC

  • Speech-Language Pathologist
  • Lehigh Acres, FL
  • NPI 1851647770
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456444800000",
    "number": "1043670458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 LEE BLVD",
            "address_2": "UNIT 106",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339364953",
            "telephone_number": "239-674-9374",
            "fax_number": "239-491-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 LEE BLVD",
            "address_2": "UNIT 106",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339364953",
            "telephone_number": "239-674-9374",
            "fax_number": "239-491-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUPPER",
        "first_name": "TAYLOR",
        "middle_name": "BLAKE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-26",
        "last_updated": "2016-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "FL",
            "license": "OTA14752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OFFICE MEDICAID #",
            "identifier": "006236000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Lehigh Acres, FL
• Occupational Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.