Healthcare Provider Details

I. General information

NPI: 1942725874
Provider Name (Legal Business Name): GEANINA MARIAH LUIS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date: 10/20/2021
Reactivation Date: 10/28/2021

III. Provider practice location address

4695 E NORTHFIELD DR
BROWNSBURG IN
46112-1784
US

IV. Provider business mailing address

1353 E MAIN ST
BROWNSBURG IN
46112-1433
US

V. Phone/Fax

Practice location:
  • Phone: 317-520-4748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: