MEDICARE: HEATHER SHOOK OT

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
1	225X00000X	Occupational Therapist	31003411A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134296478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER SHOOK OT

Provider Business Mailing Address
First Line	:	1701 S CREASY LN
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-4972
Country	:	US
Telephone Number	:	765-448-1758
Fax Number	:	765-448-3898

Provider Business Practice Location Address
First Line	:	80 PROFESSIONAL CT
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-5152
Country	:	US
Telephone Number	:	765-448-1758
Fax Number	:	765-448-3898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	05/25/2025

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Directions to “ HEATHER SHOOK OT” Practice Location

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