Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 103K00000X | Behavior Analyst | | | | No |
| 2 | 225100000X | Physical Therapist | | | | No |
| 3 | 225X00000X | Occupational Therapist | | | | No |
| 4 | 235Z00000X | Speech-Language Pathologist | | | | No |
| 5 | 251B00000X | Case Management | | | | No |
| 6 | 251C00000X | Day Training, Developmentally Disabled Services | | | | No |
| 7 | 251E00000X | Home Health | | | | No |
| 8 | 251S00000X | Community/Behavioral Health | | | | No |
| 9 | 251X00000X | Supports Brokerage | | | | No |
| 10 | 252Y00000X | Early Intervention Provider Agency | | | | No |
| 11 | 315P00000X | Intermediate Care Facility, Intellectual Disabilities | | | | No |
| 12 | 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | | No |
| 13 | 103TM1800X | Psychologist | Intellectual and Developmental Disabilities | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 200453440 | MEDICAID | INDIANA | |
| 2 | 200462800 | MEDICAID | INDIANA | |
| 3 | 100229860 | MEDICAID | INDIANA | |
| 4 | 200889040 | MEDICAID | INDIANA | |
| 5 | 200889890 B | MEDICAID | INDIANA | |
| 6 | 100239820 | MEDICAID | INDIANA | |
| 7 | 100240120 | MEDICAID | INDIANA | |
| 8 | 100249000 | MEDICAID | INDIANA | |
| 9 | 200460460 | MEDICAID | INDIANA | |
| 10 | 200494750 | MEDICAID | INDIANA | |
| 11 | 200842740 | MEDICAID | INDIANA | |
| 12 | 200889890 A | MEDICAID | INDIANA | |
| 13 | 2746210 | MEDICAID | OHIO | |
| 14 | 100244500 | MEDICAID | INDIANA | |
| 15 | 200449220 | MEDICAID | INDIANA | |
| 16 | 200460470 | MEDICAID | INDIANA | |
| 17 | 200839230 | MEDICAID | INDIANA | |
| 18 | 100244330 | MEDICAID | INDIANA | |
| 19 | 200447350 | MEDICAID | INDIANA | |
| 20 | 200453450 | MEDICAID | INDIANA | |
| 21 | 200512660 | MEDICAID | INDIANA | |
| 22 | 200889020 | MEDICAID | INDIANA | |
| 23 | 200889030 | MEDICAID | INDIANA | |
| 24 | 200460480 | MEDICAID | INDIANA | |
| 25 | 200510050 | MEDICAID | INDIANA | |
| 26 | 200714100 | OTHER | INDIANA | FIRST STEPS |
| 27 | 200824450 | MEDICAID | INDIANA | |
| 28 | 200833320 | MEDICAID | INDIANA | |
| 29 | 200897270 | MEDICAID | INDIANA | |
| 30 | 856345301 | MEDICAID | MISSOURI | |
| 31 | 100244730 | MEDICAID | INDIANA | |
| 32 | 200247700 | MEDICAID | INDIANA | |
| 33 | 200474890 | MEDICAID | INDIANA | |
| 34 | 200851580 | MEDICAID | INDIANA | |
| 35 | 200889050 | MEDICAID | INDIANA | |
