Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003399692 |
---|---|
Provider Name | Leann Vandeman |
First Address | Indianapolis, IN 46219-1979 |
Second Address | Indianapolis, IN 46219-1979 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2018 |
Last Update Date | 11/09/2018 |