Provider Demographics
NPI:1952840548
Name:MITCHELL, JAMES (OTR)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63995 THORN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IN
Mailing Address - Zip Code:46554-9174
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:63995 THORN RD
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IN
Practice Address - Zip Code:46554-9174
Practice Address - Country:US
Practice Address - Phone:574-274-1231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006510225X00000X
IN31003325A225X00000X
IDOT-1436225X00000X
IL056.011279225X00000X
WAOT 60524054225X00000X
IA082405225X00000X
CA16888225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist