Healthcare Provider Details

I. General information

NPI: 1972978096
Provider Name (Legal Business Name): LAFONDA MCKEE MOT,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 E MOORES PIKE FL 3
BLOOMINGTON IN
47401-7129
US

IV. Provider business mailing address

5485 S BRIGADIER BLVD
BLOOMINGTON IN
47401-1000
US

V. Phone/Fax

Practice location:
  • Phone: 812-334-7604
  • Fax: 812-334-7705
Mailing address:
  • Phone: 832-349-6924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31005960A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: