Provider Demographics
NPI:1417161480
Name:LEWIS, ELAINE SUSAN (MS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:SUSAN
Last Name:LEWIS
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 1:5736 E NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-5920
Mailing Address - Country:US
Mailing Address - Phone:317-652-7330
Mailing Address - Fax:317-322-0282
Practice Address - Street 1:5736 E NEW YORK ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-5920
Practice Address - Country:US
Practice Address - Phone:317-652-7330
Practice Address - Fax:317-322-0282
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002991A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist