Provider Demographics
NPI:1841698073
Name:THERAPY RESOURCES OF INDIANA
Entity type:Organization
Organization Name:THERAPY RESOURCES OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERNER
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:317-965-8675
Mailing Address - Street 1:177 BRIDGEMOR LN
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-7303
Mailing Address - Country:US
Mailing Address - Phone:317-965-8675
Mailing Address - Fax:317-483-3260
Practice Address - Street 1:7855 S EMERSON AVE STE H
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8669
Practice Address - Country:US
Practice Address - Phone:317-300-0370
Practice Address - Fax:317-300-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000102A261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1780857201Medicare UPIN