Provider Demographics
NPI:1679028328
Name:WINSTEAD, GRACE ELAINE (MS, OTR)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ELAINE
Last Name:WINSTEAD
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 1:13809 SPRINGMILL RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7900
Mailing Address - Country:US
Mailing Address - Phone:319-621-2626
Mailing Address - Fax:
Practice Address - Street 1:1118 W CROSS ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-9530
Practice Address - Country:US
Practice Address - Phone:765-274-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006191A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist