Provider Demographics
NPI:1518150762
Name:GILL, CAROLINE SUE (MS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:SUE
Last Name:GILL
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 MAXWELL RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-3433
Mailing Address - Country:US
Mailing Address - Phone:317-783-2993
Mailing Address - Fax:
Practice Address - Street 1:127 MAXWELL RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-3433
Practice Address - Country:US
Practice Address - Phone:317-783-2993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000352A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist