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General NPI Number Information
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NPI Number | 1891332532
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Entity Type | Individual
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Provider Name | TUSHAR PRAKASH LOTHE
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Gender | Male
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Dates
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Enumeration Date | 12/02/2019
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Last Update Date | 12/02/2019
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Provider Practice Location Address
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Address Line | 5080 N STATE ROAD 135 STE G
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City | BARGERSVILLE
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State | IN
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Zip | 46106-8931
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Country | US
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Telephone | 317-403-9670
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Fax | 317-893-2675
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Provider Business Mailing Address
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Address Line | 3038 ALDWYCH CT
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City | GREENWOOD
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State | IN
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Zip | 46143-6942
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Country | US
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Telephone | 317-403-9670
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Fax | 317-893-2675
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31001718A
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License Number State | IN
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