MEDICARE: LYNDA C DEITCHLE

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	31003574A	IN

General Provider Information

NPI Number	:	1801129853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDA C DEITCHLE

Provider Business Mailing Address
First Line	:	4306 N PARK AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1833
Country	:	US
Telephone Number	:	317-971-9770
Fax Number	:

Provider Business Practice Location Address
First Line	:	4306 N PARK AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1833
Country	:	US
Telephone Number	:	317-971-9770
Fax Number	:

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

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	09/09/2009

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Directions to “ LYNDA C DEITCHLE ” Practice Location

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