Provider Demographics
NPI:1720137367
Name:WOOD, GREGORY D (OTR)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:WOOD
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47327-9775
Mailing Address - Country:US
Mailing Address - Phone:765-541-8307
Mailing Address - Fax:
Practice Address - Street 1:1941 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2833
Practice Address - Country:US
Practice Address - Phone:756-827-7964
Practice Address - Fax:765-827-6430
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT006358000OtherMEDICARE GROUP PIN
UT006358000OtherMEDICARE GROUP PIN