Healthcare Provider Details

I. General information

NPI: 1083532840
Provider Name (Legal Business Name): NINA DEADY OTD, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12460 BREAKLINES ST APT 309
CARMEL IN
46032-7664
US

IV. Provider business mailing address

12460 BREAKLINES ST APT 309
CARMEL IN
46032-7664
US

V. Phone/Fax

Practice location:
  • Phone: 317-558-9598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31009106A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: