Healthcare Provider Details

I. General information

NPI: 1124668892
Provider Name (Legal Business Name): INNOVATION THERAPY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 S STATE ROAD 57
WASHINGTON IN
47501-4374
US

IV. Provider business mailing address

7676 S 250 E
WASHINGTON IN
47501-8031
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-2203
  • Fax:
Mailing address:
  • Phone: 812-698-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ADRIA BRIANNE HAWTHORNE
Title or Position: OWNER, OCCUPATIONAL THERAPIST
Credential: MSOT, OTR
Phone: 812-254-2203