Healthcare Provider Details

I. General information

NPI: 1770800161
Provider Name (Legal Business Name): NICHOLE ANN OSWALD MOT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N 17TH AVE
BEECH GROVE IN
46107-1169
US

IV. Provider business mailing address

501 N 17TH AVE
BEECH GROVE IN
46107-1169
US

V. Phone/Fax

Practice location:
  • Phone: 317-353-7007
  • Fax:
Mailing address:
  • Phone: 317-353-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number31004430A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: