Healthcare Provider Details

I. General information

NPI: 1083976112
Provider Name (Legal Business Name): MARION KATHLEEN MARTIN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARION KATHLEEN BLUESTEIN AUD

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 03/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 CHARLESTOWN RD
NEW ALBANY IN
47150-2560
US

IV. Provider business mailing address

2542 CHARLESTOWN RD
NEW ALBANY IN
47150-2560
US

V. Phone/Fax

Practice location:
  • Phone: 812-590-4843
  • Fax:
Mailing address:
  • Phone: 812-590-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number101739
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number100547
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: