Provider Demographics
NPI:1538171087
Name:ENGLE, MARYJO (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:MS
First Name:MARYJO
Middle Name:
Last Name:ENGLE
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9477 GRINNELL ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3253
Mailing Address - Country:US
Mailing Address - Phone:317-876-7042
Mailing Address - Fax:317-329-1001
Practice Address - Street 1:7112 ZIONSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2163
Practice Address - Country:US
Practice Address - Phone:317-329-1000
Practice Address - Fax:317-329-1001
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000367A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000365568OtherANTHEM INSURANCE