Provider Demographics
NPI:1205505740
Name:CREGAR, KELLY ANN
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:CREGAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18010 HASKINS RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-1614
Mailing Address - Country:US
Mailing Address - Phone:440-781-2528
Mailing Address - Fax:
Practice Address - Street 1:12496 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:HUNTSBURG
Practice Address - State:OH
Practice Address - Zip Code:44046-9792
Practice Address - Country:US
Practice Address - Phone:440-901-1745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT011693225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist