Provider Demographics
NPI:1952124703
Name:MINDFUL MOBILITY
Entity type:Organization
Organization Name:MINDFUL MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR, DRP
Authorized Official - Phone:765-228-2219
Mailing Address - Street 1:2270 INKE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-9228
Mailing Address - Country:US
Mailing Address - Phone:765-228-2219
Mailing Address - Fax:833-523-2388
Practice Address - Street 1:2270 INKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-9228
Practice Address - Country:US
Practice Address - Phone:765-228-2219
Practice Address - Fax:833-523-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community MobilityGroup - Single Specialty