Provider Demographics
NPI:1356633291
Name:FALLIS, VICKIE LEE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:LEE
Last Name:FALLIS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-8909
Mailing Address - Country:US
Mailing Address - Phone:812-934-6624
Mailing Address - Fax:812-934-6219
Practice Address - Street 1:321 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-8909
Practice Address - Country:US
Practice Address - Phone:812-934-6624
Practice Address - Fax:812-934-6219
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN320000193A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant