Healthcare Provider Details

I. General information

NPI: 1093388985
Provider Name (Legal Business Name): PAT'S PALS THERAPY RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5422 E COUNTY ROAD 600 S
PLAINFIELD IN
46168-8638
US

IV. Provider business mailing address

5422 E COUNTY ROAD 600 S
PLAINFIELD IN
46168-8638
US

V. Phone/Fax

Practice location:
  • Phone: 317-837-1417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ALEXANDRIA WATKINS
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTD, OTR
Phone: 317-837-1417