Provider Demographics
NPI:1295929313
Name:LUTTRELL STROUP, THERESA A (OTR)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:LUTTRELL STROUP
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:A
Other - Last Name:STROUP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:750 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9919 TOWNE RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8260
Practice Address - Country:US
Practice Address - Phone:317-872-4166
Practice Address - Fax:317-872-3230
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000264A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200863570OtherFIRST STEPS
IN200503920Medicaid