Individual
MRS. MANDY LYNN HIGGINBOTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
450 8TH AVE., TERRE HAUTE, IN 47804-2780
(812) 238-7362
Mailing address
450 8TH AVE, TERRE HAUTE, IN 47804-4030
(812) 238-7171
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31003545A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31003545A
STATE LICENSE NUMBER
IN
Enumeration date
01/05/2011
Last updated
02/18/2014
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