MEDICARE: TERRI LEE EVERITT

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	104100000X	Social Worker	33001079A	IN

General Provider Information

NPI Number	:	1396477949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI LEE EVERITT

Provider Business Mailing Address
First Line	:	1801 WATERMARK DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-7088
Country	:	US
Telephone Number	:	614-438-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 N KEYSTONE AVE STE 150
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1562
Country	:	US
Telephone Number	:	317-475-9294
Fax Number	:

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

Provider Enumeration Date	:	06/30/2022
Last Update Date	:	06/30/2022

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Directions to “ TERRI LEE EVERITT ” Practice Location

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