Provider Demographics
NPI:1649481342
Name:HALE, ELIZABETH KATHLEEN (OTR)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KATHLEEN
Last Name:HALE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6588 SALEM DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4729
Mailing Address - Country:US
Mailing Address - Phone:317-850-0188
Mailing Address - Fax:
Practice Address - Street 1:6588 SALEM DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-4729
Practice Address - Country:US
Practice Address - Phone:317-850-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001925A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200703180OtherFIRST STEPS GROUP NUMBER
IN200603500OtherFIRST STEPS RENDERING
IN200621480OtherFIRST STEPS RENDERING NUMBER