Provider Demographics
NPI:1548774029
Name:DUBEY, INDRAKSHI
Entity type:Individual
Prefix:
First Name:INDRAKSHI
Middle Name:
Last Name:DUBEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8618 EDENFIELD CV
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7319
Mailing Address - Country:US
Mailing Address - Phone:901-830-9899
Mailing Address - Fax:
Practice Address - Street 1:1880 GOODMAN RD E
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9552
Practice Address - Country:US
Practice Address - Phone:662-483-1049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2377225X00000X
MS0T3445225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist