Healthcare Provider Details

I. General information

NPI: 1255784849
Provider Name (Legal Business Name): EXCEEDING EXPECTATIONS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 E COUNTY ROAD 1000 S
CLAYTON IN
46118-9266
US

IV. Provider business mailing address

2227 E COUNTY ROAD 1000 S
CLAYTON IN
46118-9266
US

V. Phone/Fax

Practice location:
  • Phone: 317-539-5190
  • Fax: 317-539-5191
Mailing address:
  • Phone: 317-539-5190
  • Fax: 317-539-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31000751A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23001907A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22002834A
License Number StateIN

VIII. Authorized Official

Name: SHEILA D STARBUCK
Title or Position: OCCUPATIONAL THERAPIST/OWNER
Credential: OT
Phone: 317-539-3190