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Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OT

Contact information

Practice address
3700 LAFEYETTE PARKWAY, FLOYDS KNOBS, IN 47119
(812) 923-4888
Mailing address
9480 PRIORITY WAY WEST DR., INDIANAPOLIS, IN 46240

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31006147A
IN

Other

Enumeration date
10/07/2016
Last updated
10/07/2016
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