Healthcare Provider Details

I. General information

NPI: 1831237544
Provider Name (Legal Business Name): TAMI LEE THORNTON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 10/07/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E. WALNUT STREET
INDIANAPOLIS IN
46204-1312
US

IV. Provider business mailing address

12037 EAGLEVIEW DR
ZIONSVILLE IN
46077-4621
US

V. Phone/Fax

Practice location:
  • Phone: 317-226-4000
  • Fax:
Mailing address:
  • Phone: 602-761-0325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31006571A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3317
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: