Provider Demographics
NPI:1154891182
Name:DUCREPIN, KETHIA (OTR/L)
Entity type:Individual
Prefix:
First Name:KETHIA
Middle Name:
Last Name:DUCREPIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 MERION TRCE APT B401
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1747
Mailing Address - Country:US
Mailing Address - Phone:857-244-4698
Mailing Address - Fax:
Practice Address - Street 1:7200 MERION TRCE APT B401
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1747
Practice Address - Country:US
Practice Address - Phone:857-244-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA015720225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist