Healthcare Provider Details

I. General information

NPI: 1013834779
Provider Name (Legal Business Name): LILLY MAE SNIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILLY GHERING

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5976 PORCHESTER PL
PLAINFIELD IN
46168-7570
US

IV. Provider business mailing address

5976 PORCHESTER PL
PLAINFIELD IN
46168-7570
US

V. Phone/Fax

Practice location:
  • Phone: 620-714-1649
  • Fax:
Mailing address:
  • Phone: 620-714-1649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224ZE0001X
TaxonomyEnvironmental Modification Occupational Therapy Assistant
License Number99137385A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: