Healthcare Provider Details

I. General information

NPI: 1679492649
Provider Name (Legal Business Name): OCTAVIA WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2346 S LYNHURST DR BLDG 100
INDIANAPOLIS IN
46241-5171
US

IV. Provider business mailing address

2346 S LYNHURST DR BLDG 100
INDIANAPOLIS IN
46241-5171
US

V. Phone/Fax

Practice location:
  • Phone: 317-927-8830
  • Fax:
Mailing address:
  • Phone: 317-927-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: