Healthcare Provider Details

I. General information

NPI: 1376450312
Provider Name (Legal Business Name): MADELINE ELIZABETH NEELY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10340 PLEASANT ST STE 100
NOBLESVILLE IN
46060-3947
US

IV. Provider business mailing address

19394 FOX CHASE DR
NOBLESVILLE IN
46062-6674
US

V. Phone/Fax

Practice location:
  • Phone: 317-417-7991
  • Fax:
Mailing address:
  • Phone: 317-417-7991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31009158A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: