Healthcare Provider Details

I. General information

NPI: 1568889236
Provider Name (Legal Business Name): JOANN RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 N MAIN ST
FRANKLIN IN
46131-1251
US

IV. Provider business mailing address

1178 N MAIN ST
FRANKLIN IN
46131-1251
US

V. Phone/Fax

Practice location:
  • Phone: 812-343-2797
  • Fax:
Mailing address:
  • Phone: 812-343-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31005639A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: