Healthcare Provider Details

I. General information

NPI: 1851781835
Provider Name (Legal Business Name): JESSIE SALLEY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSIE HALLE

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 HARCOURT RD
INDIANAPOLIS IN
46260-2046
US

IV. Provider business mailing address

8501 HARCOURT RD
INDIANAPOLIS IN
46260-2046
US

V. Phone/Fax

Practice location:
  • Phone: 317-875-9105
  • Fax: 317-872-6873
Mailing address:
  • Phone: 317-875-9105
  • Fax: 317-872-6873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number31006086A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31006086A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: