Provider Demographics
NPI:1629603832
Name:TSHILILIWA, VIMBAI EMMACULATE
Entity Type:Individual
Prefix:
First Name:VIMBAI
Middle Name:EMMACULATE
Last Name:TSHILILIWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13281 E LETTS LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-5506
Mailing Address - Country:US
Mailing Address - Phone:269-270-2541
Mailing Address - Fax:
Practice Address - Street 1:8505 WOODFIELD CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4309
Practice Address - Country:US
Practice Address - Phone:317-466-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003258A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist