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NPI Code Detail

MEDICARE: MISS JESSICA GROGAN OTR

MEDICARE: MISS JESSICA GROGAN OTR
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
1225XH1200XHand Occupational Therapist31003972AIN
2225X00000XOccupational Therapist31003972AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00708058OTHERINRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
131003972AOTHERINSTATE LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841269511
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JESSICA GROGAN OTR
Provider Business Mailing Address
First Line : 8501 HARCOURT RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2046
Country : US
Telephone Number : 317-875-9105
Fax Number : 317-808-8802
Provider Business Practice Location Address
First Line : 8501 HARCOURT RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2046
Country : US
Telephone Number : 317-875-9105
Fax Number : 317-808-8802
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 05/24/2024

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Directions to “ MISS JESSICA GROGAN OTR” Practice Location

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