Provider Demographics
NPI:1982370771
Name:DELOSSANTOS, JOHN M (OTR/L, MBA, RAC-CT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:DELOSSANTOS
Suffix:
Gender:M
Credentials:OTR/L, MBA, RAC-CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4904 WOODFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-9427
Mailing Address - Country:US
Mailing Address - Phone:317-752-2209
Mailing Address - Fax:317-688-8015
Practice Address - Street 1:4904 WOODFIELD DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-9427
Practice Address - Country:US
Practice Address - Phone:317-752-2209
Practice Address - Fax:317-688-8015
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility