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General NPI Number Information
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NPI Number | 1952124703
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Entity Type | Organization
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Legal Business Name | MINDFUL MOBILITY
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 2270 INKE RD
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City | RICHMOND
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State | IN
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Zip | 47374-9228
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Country | US
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Telephone | 765-228-2219
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Fax | 833-523-2388
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Provider Business Mailing Address
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Address Line | 2270 INKE RD
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City | RICHMOND
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State | IN
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Zip | 47374-9228
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Country | US
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Telephone | 765-228-2219
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Fax | 833-523-2388
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Authorized Official
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Title or Position | OWNER
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Name | MRS. STEPHANIE NICHOLE PIERSON
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Credential | MS, OTR, DRP
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Telephone | 765-228-2219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XR0403X
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Taxonomy Name | Driving and Community Mobility Occupational Therapist
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License Number |
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License Number State |
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