Healthcare Provider Details

I. General information

NPI: 1093419467
Provider Name (Legal Business Name): MADISEN ASHLEY RUPE RBT, MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 GUION RD
INDIANAPOLIS IN
46222-1617
US

IV. Provider business mailing address

7901 E 88TH ST
INDIANAPOLIS IN
46256-1235
US

V. Phone/Fax

Practice location:
  • Phone: 317-483-1187
  • Fax: 317-842-5911
Mailing address:
  • Phone: 317-849-5437
  • Fax: 317-842-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31009100A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-249147
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: