=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376813014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALOTTA THERAPY,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2012
-----------------------------------------------------
Last Update Date | 01/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8900 COBBLER LN
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47905-7720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-412-0788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8900 COBBLER LN
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47905-7720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-412-0788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FACILITY MANAGER
-----------------------------------------------------
Name | MRS. SHANNON TAWN HARRIS
-----------------------------------------------------
Credential | ST
-----------------------------------------------------
Telephone | 765-412-0788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 31004248A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 22004133A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 05009075A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------