Provider Demographics
NPI:1851014377
Name:SEALS, JODY (OTR)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:SEALS
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 1:300 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LOOGOOTEE
Mailing Address - State:IN
Mailing Address - Zip Code:47553-1708
Mailing Address - Country:US
Mailing Address - Phone:812-709-3286
Mailing Address - Fax:
Practice Address - Street 1:300 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-1708
Practice Address - Country:US
Practice Address - Phone:812-709-3286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2025-08-26
Deactivation Date:2025-05-22
Deactivation Code:
Reactivation Date:2025-08-21
Provider Licenses
StateLicense IDTaxonomies
INRBT-22-235707106S00000X
IN31008709A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician