Healthcare Provider Details

I. General information

NPI: 1417088758
Provider Name (Legal Business Name): LISA SHEPHERD PEARCY O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10294 E 96TH ST
FISHERS IN
46037-9497
US

IV. Provider business mailing address

9133 PRAIRIE RIDGE CT
INDIANAPOLIS IN
46256-3499
US

V. Phone/Fax

Practice location:
  • Phone: 317-288-7572
  • Fax: 317-284-1765
Mailing address:
  • Phone: 317-570-4023
  • Fax: 317-228-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number3100218A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: