Provider Demographics
NPI:1639381551
Name:VETETO, KARRIE (BCBA)
Entity Type:Individual
Prefix:
First Name:KARRIE
Middle Name:
Last Name:VETETO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KARRIE
Other - Middle Name:
Other - Last Name:BLAGRAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:7726 CASTLE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3456
Mailing Address - Country:US
Mailing Address - Phone:317-466-1000
Mailing Address - Fax:317-466-2000
Practice Address - Street 1:4740 KINGSWAY DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1521
Practice Address - Country:US
Practice Address - Phone:317-466-1000
Practice Address - Fax:317-466-2000
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004285A225X00000X
IN1-13-14734103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100462120Medicaid
IN156501Medicare PIN