Provider Demographics
NPI:1972975928
Name:MAYBERRY, AUBREY (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10367 S STATE ROAD 13
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-9247
Mailing Address - Country:US
Mailing Address - Phone:317-579-5930
Mailing Address - Fax:
Practice Address - Street 1:10367 S STATE ROAD 13
Practice Address - Street 2:
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040-9247
Practice Address - Country:US
Practice Address - Phone:317-579-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99069835A225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist