Provider Demographics
NPI:1144474727
Name:OKELEY, CRAIG SCOTT (PTA)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:SCOTT
Last Name:OKELEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 S NEWMAN RD
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-4354
Mailing Address - Country:US
Mailing Address - Phone:765-427-1738
Mailing Address - Fax:765-464-5654
Practice Address - Street 1:51 S NEWMAN RD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-4354
Practice Address - Country:US
Practice Address - Phone:765-427-1738
Practice Address - Fax:765-464-5654
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002989A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant