MEDICARE: MS. MARTHA LYNNE KILGORE L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2005	AL
2	101YP2500X	Professional Counselor	2005AL	AL

General Provider Information

NPI Number	:	1093870446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA LYNNE KILGORE L.P.C.

Provider Business Mailing Address
First Line	:	425 5TH AVE NW
Second Line	:
City	:	ATTALLA
State	:	AL
Zip	:	35954-2214
Country	:	US
Telephone Number	:	256-492-7800
Fax Number	:	256-494-5536

Provider Business Practice Location Address
First Line	:	301 14TH ST NW
Second Line	:
City	:	FT. PAYNE
State	:	AL
Zip	:	35967-3155
Country	:	US
Telephone Number	:	256-845-4571
Fax Number	:	256-845-4582

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	09/26/2011

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