Basic Information
| Provider Information | |||||||||
| NPI: | 1124668892 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INNOVATION THERAPY, LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7676 S 250 E | ||||||||
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| City: | WASHINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475018031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126980198 | ||||||||
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| Practice Location | |||||||||
| Address1: | 933 S STATE ROAD 57 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475014374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122542203 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2020 | ||||||||
| LastUpdateDate: | 01/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | HAWTHORNE | ||||||||
| AuthorizedOfficialFirstName: | ADRIA | ||||||||
| AuthorizedOfficialMiddleName: | BRIANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, OCCUPATIONAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8122542203 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MSOT, OTR | ||||||||
| NPICertificationDate: | 01/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.