Provider Demographics
NPI:1013528959
Name:INGRAM, GABRIELLE KARLENE (MS, OTD, OTR)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:KARLENE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MS, OTD, OTR
Other - Prefix:
Other - First Name:GABBY
Other - Middle Name:KARLENE
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, OTD, OTR
Mailing Address - Street 1:212 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-9482
Mailing Address - Country:US
Mailing Address - Phone:812-639-4900
Mailing Address - Fax:
Practice Address - Street 1:4200 WYNTREE DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2581
Practice Address - Country:US
Practice Address - Phone:812-213-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007159A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist