Individual
REBECCA ANN REQUARTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSOT
Contact information
Practice address
6635 EAST 21ST STREET, SUITE 100, WEST BUILDING, INDIANAPOLIS, IN 46219-2254
(317) 608-2824
(765) 454-9759
Mailing address
3500 DEPAUW BOULEVARD, SUITE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(765) 454-9759
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31005435A
IN
225XP0200X
Pediatric Occupational Therapist
31005435A
IN
Other
Enumeration date
02/14/2013
Last updated
04/04/2018
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