Healthcare Provider Details

I. General information

NPI: 1184899593
Provider Name (Legal Business Name): FEEDING FRIENDS CHILDREN'S FEEDING CLINIC AND THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 E 75TH ST STE 206
INDIANAPOLIS IN
46250
US

IV. Provider business mailing address

6330 E 75TH ST STE 206
INDIANAPOLIS IN
46250-2700
US

V. Phone/Fax

Practice location:
  • Phone: 317-284-1166
  • Fax: 317-284-1559
Mailing address:
  • Phone: 317-284-1166
  • Fax: 317-284-1559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number31003434A
License Number StateIN

VIII. Authorized Official

Name: DR. COLLEEN M WASEMANN
Title or Position: CO-OWNER
Credential: OTD, MS, OTR
Phone: 317-753-0930