Provider Demographics
NPI:1043394737
Name:ALTSTADT, SHIRLEY DUOOS (OTR)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:DUOOS
Last Name:ALTSTADT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 THORNHURST DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1413
Mailing Address - Country:US
Mailing Address - Phone:317-846-2464
Mailing Address - Fax:317-846-2464
Practice Address - Street 1:37 THORNHURST DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1413
Practice Address - Country:US
Practice Address - Phone:317-846-2464
Practice Address - Fax:317-846-2464
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002708A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200657040Medicare UPIN