MEDICARE: KATHY K GATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	373H00000X	Day Training/Habilitation Specialist
2	376J00000X	Homemaker
3	385H00000X	Respite Care
4	385HR2055X	Child Mental Illness Respite Care
5	385HR2065X	Child Physical Disabilities Respite Care
6	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care

General Provider Information

NPI Number	:	1851883102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY K GATES

Provider Business Mailing Address
First Line	:	1304 MORNINGTON DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-8608
Country	:	US
Telephone Number	:	317-693-0649
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 MORNINGTON DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-8608
Country	:	US
Telephone Number	:	317-693-0649
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2018
Last Update Date	:	06/02/2018

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