=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255784849
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCEEDING EXPECTATIONS THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2016
-----------------------------------------------------
Last Update Date | 07/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2227 E COUNTY ROAD 1000 S
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46118-9266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-539-5190
-----------------------------------------------------
Fax | 317-539-5191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2227 E COUNTY ROAD 1000 S
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46118-9266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-539-5190
-----------------------------------------------------
Fax | 317-539-5191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST/OWNER
-----------------------------------------------------
Name | SHEILA D STARBUCK
-----------------------------------------------------
Credential | OT
-----------------------------------------------------
Telephone | 317-539-3190
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 23001907A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 22002834A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 31000751A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------