Allison Lee Antolin, MS, OTR
Individual provider Active NPI Pediatric Occupational Therapist · Greenwood, IN
NPI 1609365535 · NPPES record last updated Feb 20, 2019
Key facts
- NPI
- 1609365535
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Occupational Therapist 225XP0200X
- License
- 31002997A (IN)
- Practice address
- 21 South Park Blvd., Suite 21
Greenwood, IN 46143-8838 - Phone
- (317) 449-2104
- Fax
- (317) 520-8200
- NPI assigned
- May 7, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250124000882 | IN | Practitioner - Occupational Therapist in Private Practice | 9931638699 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31002997A | IN | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anew Therapy & Wellness LLC | Current |
Accepting new patients | |
| Anew Therapy & Wellness LLC | Current |
Accepting new patients |
Locations
6900 Gray Rd
Indianapolis, IN 46237
Phone (317) 788-2500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 31002997A | IN | Yes |
Addresses
Primary practice location
21 South Park Blvd., Suite 21
Greenwood, IN 46143-8838
Mailing address
3500 Depauw Blvd., Suite 3070
Indianapolis, IN 46238-6135
Phone (317) 449-4833
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1034906 | Other | NBCOT BOARD CERTIFICATION | |
| 300018235 | Medicaid | IN |
Other names
- Allison Lee Northam
Other providers in Greenwood, IN
- Denise Boling Angel
- Angela M. Tomlin, PH.D.
- Alexandria Lynn Angerer
- Asif Ansari
- Hannah Marie Anspaugh
- Alyssa Antone
- Leslie M Antonelli
- Elizabeth Connell Anttonen
- Apexgen Medical Billing LLC
- Sydney Apple
All providers in Greenwood, IN · Pediatric Occupational Therapist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.