MEDICARE: CARISSA RUSK

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1508670498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA RUSK

Provider Business Mailing Address
First Line	:	7121 OLD HOUSE RD APT B
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-2842
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7121 OLD HOUSE RD APT B
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-2842
Country	:	US
Telephone Number	:	317-937-0951
Fax Number	:

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

Provider Enumeration Date	:	02/03/2025
Last Update Date	:	02/03/2025

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Directions to “ CARISSA RUSK ” Practice Location

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