Provider Demographics
NPI:1154211985
Name:GILLEN, GRACE MARY (OTR)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MARY
Last Name:GILLEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8122 TANAGER CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1775
Mailing Address - Country:US
Mailing Address - Phone:765-720-4424
Mailing Address - Fax:
Practice Address - Street 1:9957 ALLISONVILLE RD STE LL
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2006
Practice Address - Country:US
Practice Address - Phone:317-841-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31008738A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist