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General NPI Number Information
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NPI Number | 1447333786
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Entity Type | Organization
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Legal Business Name | OLD NATIONAL TRAIL SPECIAL SERVICES COOPERATIVE
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 522 ANDERSON ST
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City | GREENCASTLE
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State | IN
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Zip | 46135-1729
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Country | US
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Telephone | 765-653-2781
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Fax | 765-653-6110
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Provider Business Mailing Address
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Address Line | 522 ANDERSON ST P.O. BOX 267
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City | GREENCASTLE
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State | IN
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Zip | 46135-1729
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Country | US
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Telephone | 765-653-2781
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Fax | 765-653-6110
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. NANCY JANE HOLSAPPLE
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Credential |
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Telephone | 765-653-2781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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