MEDICARE: KAMORA MARY ALICE MARTIN

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	106S00000X	Behavior Technician		IN

General Provider Information

NPI Number	:	1902779861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMORA MARY ALICE MARTIN

Provider Business Mailing Address
First Line	:	5814 COUNTESS DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7416
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5814 COUNTESS DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7416
Country	:	US
Telephone Number	:	630-506-1235
Fax Number	:

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

Provider Enumeration Date	:	09/26/2025
Last Update Date	:	10/24/2025

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Directions to “ KAMORA MARY ALICE MARTIN ” Practice Location

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