Provider Demographics
NPI:1013615707
Name:KRACHT, LETITIA
Entity Type:Individual
Prefix:
First Name:LETITIA
Middle Name:
Last Name:KRACHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TISH
Other - Middle Name:
Other - Last Name:KRACHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2152 MUSTANG CHASE DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8184
Mailing Address - Country:US
Mailing Address - Phone:317-513-1419
Mailing Address - Fax:
Practice Address - Street 1:2152 MUSTANG CHASE DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46074-8184
Practice Address - Country:US
Practice Address - Phone:317-513-1419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist