Healthcare Provider Details

I. General information

NPI: 1932063633
Provider Name (Legal Business Name): ALEXANDRA MEGAN GAMBREL OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 CHESTER BLVD
RICHMOND IN
47374-1235
US

IV. Provider business mailing address

1100 REID PKWY
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-983-3092
  • Fax:
Mailing address:
  • Phone: 765-983-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number31007792A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: