Provider Demographics
NPI:1750076212
Name:INGRAM, LEVI
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:INGRAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 LIVE OAK CT
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-0701
Mailing Address - Country:US
Mailing Address - Phone:765-210-4899
Mailing Address - Fax:
Practice Address - Street 1:2312 S DIXON RD STE 250
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6426
Practice Address - Country:US
Practice Address - Phone:765-459-7275
Practice Address - Fax:800-805-4620
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001851A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant