Healthcare Provider Details

I. General information

NPI: 1063580223
Provider Name (Legal Business Name): KAMNA AGARWAL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W BETHEL AVE
MUNCIE IN
47304-5407
US

IV. Provider business mailing address

3600 W BETHEL AVE
MUNCIE IN
47304-5407
US

V. Phone/Fax

Practice location:
  • Phone: 765-213-3870
  • Fax: 765-213-3888
Mailing address:
  • Phone: 765-213-3870
  • Fax: 765-213-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31002320A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: