Healthcare Provider Details

I. General information

NPI: 1689916397
Provider Name (Legal Business Name): LAIKE DANIELLE NELSON MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9919 TOWNE RD
CARMEL IN
46032-8260
US

IV. Provider business mailing address

16722 AERION CT
WESTFIELD IN
46074-7310
US

V. Phone/Fax

Practice location:
  • Phone: 317-872-4166
  • Fax:
Mailing address:
  • Phone: 309-370-7758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31006332A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: