Provider Demographics
NPI:1316428089
Name:CHAMPOUX, HAVILAH S (MS, OTR)
Entity type:Individual
Prefix:MRS
First Name:HAVILAH
Middle Name:S
Last Name:CHAMPOUX
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8828 ELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-2218
Mailing Address - Country:US
Mailing Address - Phone:574-524-0036
Mailing Address - Fax:
Practice Address - Street 1:7478 SHADELAND STATION WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3925
Practice Address - Country:US
Practice Address - Phone:317-288-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist