Provider Demographics
NPI:1174629620
Name:MIRCHANDANI, NAYAN TARA (MS OTR)
Entity Type:Individual
Prefix:
First Name:NAYAN
Middle Name:TARA
Last Name:MIRCHANDANI
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:NAYAN
Other - Middle Name:TARA
Other - Last Name:MIRCHANDANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS OTR
Mailing Address - Street 1:809 HOSPITAL RD
Mailing Address - Street 2:PO BOX 466
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-7699
Mailing Address - Country:US
Mailing Address - Phone:317-738-6950
Mailing Address - Fax:317-534-1034
Practice Address - Street 1:809 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-7699
Practice Address - Country:US
Practice Address - Phone:317-738-6950
Practice Address - Fax:317-534-1034
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000117A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200602000OtherRENDERING FS
IN100314180AMedicaid
IN200429410AMedicaid
IN200701710AOtherFIRST STEPS