Provider Demographics
NPI:1811264641
Name:GREGORY, CARLETTA SUE (MT-BC)
Entity type:Individual
Prefix:
First Name:CARLETTA
Middle Name:SUE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 POLK ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47660-1345
Mailing Address - Country:US
Mailing Address - Phone:812-779-6558
Mailing Address - Fax:
Practice Address - Street 1:621 S CULLEN AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4137
Practice Address - Country:US
Practice Address - Phone:812-491-9400
Practice Address - Fax:812-474-2242
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist