Provider Demographics
NPI:1881869634
Name:HANCOCK, JUDITH A (MS, OTR)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:A
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6839 S LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-4731
Mailing Address - Country:US
Mailing Address - Phone:317-374-7795
Mailing Address - Fax:317-856-0258
Practice Address - Street 1:6839 S LAWNDALE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-4731
Practice Address - Country:US
Practice Address - Phone:317-374-7795
Practice Address - Fax:317-856-0258
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000322A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200650120OtherELECTRONIC DATA SOLUTIONS