Provider Demographics
NPI:1457861361
Name:UNTAPPED - PEDIATRIC THERAPIES
Entity Type:Organization
Organization Name:UNTAPPED - PEDIATRIC THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:317-753-6962
Mailing Address - Street 1:14194 STACEY ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8720
Mailing Address - Country:US
Mailing Address - Phone:317-753-6962
Mailing Address - Fax:
Practice Address - Street 1:14194 STACEY ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8720
Practice Address - Country:US
Practice Address - Phone:317-753-6962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004103A225X00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty