Provider Demographics
NPI:1184995862
Name:INDY PEDIATRIC OCCUPATIONAL THERAPY LLC
Entity type:Organization
Organization Name:INDY PEDIATRIC OCCUPATIONAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HERRING-ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:317-257-1111
Mailing Address - Street 1:911 E 86TH ST
Mailing Address - Street 2:SUITE107
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1850
Mailing Address - Country:US
Mailing Address - Phone:317-257-1111
Mailing Address - Fax:317-257-2222
Practice Address - Street 1:911 E 86TH ST
Practice Address - Street 2:SUITE107
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1850
Practice Address - Country:US
Practice Address - Phone:317-257-1111
Practice Address - Fax:317-257-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002231A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center