Provider Demographics
NPI:1023430956
Name:RUDISILE, EVA MARIA (MT-BC, DIPL MT)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:MARIA
Last Name:RUDISILE
Suffix:
Gender:F
Credentials:MT-BC, DIPL MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7237 DOVER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2440
Mailing Address - Country:US
Mailing Address - Phone:317-966-7845
Mailing Address - Fax:
Practice Address - Street 1:8481 BASH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1563
Practice Address - Country:US
Practice Address - Phone:317-595-9065
Practice Address - Fax:317-595-9067
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-12
Last Update Date:2014-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist