Provider Demographics
NPI:1124668892
Name:INNOVATION THERAPY, LLC.
Entity type:Organization
Organization Name:INNOVATION THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIA
Authorized Official - Middle Name:BRIANNE
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MSOT, OTR
Authorized Official - Phone:812-254-2203
Mailing Address - Street 1:7676 S 250 E
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-8031
Mailing Address - Country:US
Mailing Address - Phone:812-698-0198
Mailing Address - Fax:
Practice Address - Street 1:933 S STATE ROAD 57
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4374
Practice Address - Country:US
Practice Address - Phone:812-254-2203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty