Provider Demographics
NPI:1831948108
Name:TRITCH, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:TRITCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 W DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-2806
Mailing Address - Country:US
Mailing Address - Phone:260-347-8824
Mailing Address - Fax:260-458-5741
Practice Address - Street 1:1292 W DRAKE RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2806
Practice Address - Country:US
Practice Address - Phone:260-347-8824
Practice Address - Fax:260-458-5741
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000357A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist