Provider Demographics
NPI:1740948645
Name:GILMORE, ANGELINA MARIE (MA, OTR)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:MARIE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:MA, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:3351 EASTBROOK DR STE 101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5744
Practice Address - Country:US
Practice Address - Phone:970-698-8980
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0007186225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist