MEDICARE: HALEY ELIZABETH GORRELL

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
1	2255A2300X	Athletic Trainer		IN
2	390200000X	Student in an Organized Health Care Education/Training Program		IN

General Provider Information

NPI Number	:	1861326365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY ELIZABETH GORRELL

Provider Business Mailing Address
First Line	:	5901 E COUNTY ROAD 200 S
Second Line	:
City	:	GREENSBURG
State	:	IN
Zip	:	47240-7745
Country	:	US
Telephone Number	:	812-614-8897
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 E COUNTY ROAD 200 S
Second Line	:
City	:	GREENSBURG
State	:	IN
Zip	:	47240-7745
Country	:	US
Telephone Number	:	812-614-8897
Fax Number	:

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

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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Directions to “ HALEY ELIZABETH GORRELL ” Practice Location

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