Provider Demographics
NPI:1063670297
Name:FERGUSON, ADRIANNE MARCELLE (MS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANNE
Middle Name:MARCELLE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4862 E 500 S
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-8027
Mailing Address - Country:US
Mailing Address - Phone:317-738-4313
Mailing Address - Fax:
Practice Address - Street 1:4862 E 500 S
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-8027
Practice Address - Country:US
Practice Address - Phone:317-738-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002311A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist