Provider Demographics
NPI:1447333786
Name:OLD NATIONAL TRAIL SPECIAL SERVICES COOPERATIVE
Entity type:Organization
Organization Name:OLD NATIONAL TRAIL SPECIAL SERVICES COOPERATIVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HOLSAPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-653-2781
Mailing Address - Street 1:522 ANDERSON ST
Mailing Address - Street 2:P.O. BOX 267
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-1729
Mailing Address - Country:US
Mailing Address - Phone:765-653-2781
Mailing Address - Fax:765-653-6110
Practice Address - Street 1:522 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-1729
Practice Address - Country:US
Practice Address - Phone:765-653-2781
Practice Address - Fax:765-653-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty