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General NPI Number Information
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NPI Number | 1417088758
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Entity Type | Individual
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Provider Name | LISA SHEPHERD PEARCY O.T.R.
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Gender | Female
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 10294 E 96TH ST
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City | FISHERS
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State | IN
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Zip | 46037-9497
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Country | US
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Telephone | 317-288-7572
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Fax | 317-284-1765
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Provider Business Mailing Address
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Address Line | 9133 PRAIRIE RIDGE CT
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-3499
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Country | US
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Telephone | 317-570-4023
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Fax | 317-228-9163
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 3100218A
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License Number State | IN
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