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NPI Code Detail

MEDICARE: OLIVIA GRACE FOSTER BA

MEDICARE: OLIVIA GRACE FOSTER BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-20-112178IN

General Provider Information

NPI Number : 1003425661
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA GRACE FOSTER BA
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 9769 CROSSPOINT BLVD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-3346
Country : US
Telephone Number : 317-588-2732
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2020
Last Update Date : 07/29/2020

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Directions to “ OLIVIA GRACE FOSTER BA” Practice Location

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