Provider Demographics
NPI:1710134903
Name:LEDET, STACI (COTA)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:LEDET
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:
Other - Last Name:ALBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:10224 NOBLE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-7717
Mailing Address - Country:US
Mailing Address - Phone:260-243-1198
Mailing Address - Fax:
Practice Address - Street 1:10224 NOBLE CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-7717
Practice Address - Country:US
Practice Address - Phone:260-243-1198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001486A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant