MEDICARE: KELLY LYNN EPPS OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1720754864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LYNN EPPS OTR/L

Provider Business Mailing Address
First Line	:	620 E HUMMELSTOWN ST
Second Line	:
City	:	ELIZABETHTOWN
State	:	PA
Zip	:	17022-1715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7232 ROCK RIDGE AVE
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-8107
Country	:	US
Telephone Number	:	717-364-4360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2021
Last Update Date	:	08/18/2021

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