Provider Demographics
NPI:1417088758
Name:PEARCY, LISA SHEPHERD (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SHEPHERD
Last Name:PEARCY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9133 PRAIRIE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3499
Mailing Address - Country:US
Mailing Address - Phone:317-570-4023
Mailing Address - Fax:317-228-9163
Practice Address - Street 1:2902 W 86TH ST
Practice Address - Street 2:SUITE 160
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-5900
Practice Address - Country:US
Practice Address - Phone:317-228-9163
Practice Address - Fax:317-228-0205
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3100218A225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201330AMedicare ID - Type Unspecified