Provider Demographics
NPI:1851925424
Name:MCKISSOCK, HELEN BLAIR (CTRS)
Entity Type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:BLAIR
Last Name:MCKISSOCK
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 W 81ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2803
Mailing Address - Country:US
Mailing Address - Phone:317-403-9143
Mailing Address - Fax:
Practice Address - Street 1:1350 TERRY DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-9367
Practice Address - Country:US
Practice Address - Phone:317-838-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist