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NPI Code Detail

MEDICARE: CEIL WINN UPCHURCH BS, OT/L

MEDICARE: CEIL WINN UPCHURCH BS, OT/L
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
1225X00000XOccupational Therapist31003581AIN
2225XP0200XPediatric Occupational Therapist

General Provider Information

NPI Number : 1215174016
Entity Type Code : Individual
Provider Name (Legal Business Name) : CEIL WINN UPCHURCH BS, OT/L
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 765-454-9759
Provider Business Practice Location Address
First Line : 21 S PARK BLVD STE 21
Second Line :
City : GREENWOOD
State : IN
Zip : 46143-8838
Country : US
Telephone Number : 317-449-2104
Fax Number : 765-454-9759
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2009
Last Update Date : 07/21/2022

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