Healthcare Provider Details

I. General information

NPI: 1891989323
Provider Name (Legal Business Name): TERESA GORMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7772 N RUSHVILLE RD
CARTHAGE IN
46115-9773
US

IV. Provider business mailing address

7772 N RUSHVILLE RD
CARTHAGE IN
46115-9773
US

V. Phone/Fax

Practice location:
  • Phone: 317-402-2228
  • Fax:
Mailing address:
  • Phone: 317-402-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31001973A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: