Healthcare Provider Details

I. General information

NPI: 1497791966
Provider Name (Legal Business Name): LITTLE STARS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 MUESSING RD
INDIANAPOLIS IN
46239-9188
US

IV. Provider business mailing address

939 MUESSING RD
INDIANAPOLIS IN
46239-9188
US

V. Phone/Fax

Practice location:
  • Phone: 317-319-3693
  • Fax:
Mailing address:
  • Phone: 317-319-3693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31002758A
License Number StateIN

VIII. Authorized Official

Name: MS. ELIZABETH E. MAJOR
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 317-319-3693