Provider Demographics
NPI:1083272280
Name:COLLINS, LAYKIN ELISABETH (COTA)
Entity Type:Individual
Prefix:
First Name:LAYKIN
Middle Name:ELISABETH
Last Name:COLLINS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:LAYKIN
Other - Middle Name:ELISABETH
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:8921 TIMBERS WAY APT 127
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9132
Mailing Address - Country:US
Mailing Address - Phone:812-593-3830
Mailing Address - Fax:
Practice Address - Street 1:118 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3323
Practice Address - Country:US
Practice Address - Phone:317-844-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32003412A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant