Provider Demographics
NPI:1417040049
Name:RIDGE, JILL ANN
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:RIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANN
Other - Last Name:STUDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR, CHT
Mailing Address - Street 1:8501 HARCOURT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260
Mailing Address - Country:US
Mailing Address - Phone:317-875-9105
Mailing Address - Fax:317-875-8638
Practice Address - Street 1:8501 HARCOURT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-875-9105
Practice Address - Fax:317-875-8638
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003075A225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000185049OtherANTHEM HEALTH PLAN
IN062110023OtherMEDICARE PTAN
INP00708373OtherRR MEDICARE
IN200250070Medicaid
IN200250070Medicaid
IN156524Medicare PIN