Provider Demographics
NPI:1740046713
Name:ROOTED OCCUPATIONAL THERAPY, LLC
Entity type:Organization
Organization Name:ROOTED OCCUPATIONAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIETHOLTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR
Authorized Official - Phone:574-312-4005
Mailing Address - Street 1:11463 MEADOWLARK CIR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4609
Mailing Address - Country:US
Mailing Address - Phone:574-312-4005
Mailing Address - Fax:
Practice Address - Street 1:11463 MEADOWLARK CIR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-4609
Practice Address - Country:US
Practice Address - Phone:574-312-4005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty