Healthcare Provider Details

I. General information

NPI: 1497610331
Provider Name (Legal Business Name): GRACE WILLMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9002 N MERIDIAN ST STE 111
INDIANAPOLIS IN
46260-5377
US

IV. Provider business mailing address

11115 MANTEO CT
FISHERS IN
46040-9135
US

V. Phone/Fax

Practice location:
  • Phone: 317-779-3530
  • Fax:
Mailing address:
  • Phone: 317-438-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number86453
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number545715
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: