MEDICARE: KATELYN NICOLE GILMORE MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	106S00000X	Behavior Technician	RBT-22-205955	IN

General Provider Information

NPI Number	:	1215510151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN NICOLE GILMORE MA

Provider Business Mailing Address
First Line	:	8063 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6001
Country	:	US
Telephone Number	:	845-826-3721
Fax Number	:

Provider Business Practice Location Address
First Line	:	8063 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6001
Country	:	US
Telephone Number	:	845-826-3721
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2021
Last Update Date	:	02/14/2025

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