Provider Demographics
NPI:1720961501
Name:GILLESPIE, NATALIE ANN (OTA)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANN
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:ANN
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:913 W MARKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-6114
Mailing Address - Country:US
Mailing Address - Phone:765-210-7296
Mailing Address - Fax:765-210-7296
Practice Address - Street 1:913 W MARKLAND AVE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6114
Practice Address - Country:US
Practice Address - Phone:765-210-7296
Practice Address - Fax:765-210-7296
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002685A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant