Healthcare Provider Details

I. General information

NPI: 1083309009
Provider Name (Legal Business Name): CAILY MARIE FRIEL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 BROADWAY
CROWN POINT IN
46307-8001
US

IV. Provider business mailing address

655 S WILLOW ST STE 128
MANCHESTER NH
03103-5723
US

V. Phone/Fax

Practice location:
  • Phone: 219-661-6100
  • Fax:
Mailing address:
  • Phone: 800-955-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT24113
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.015371
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31008681A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: