Provider Demographics
NPI:1750050977
Name:SENIOR OUTPATIENT SERVICES
Entity Type:Organization
Organization Name:SENIOR OUTPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:GARTEE
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR
Authorized Official - Phone:574-333-9747
Mailing Address - Street 1:1220 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-4419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1220 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-4419
Practice Address - Country:US
Practice Address - Phone:574-333-9747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health