Healthcare Provider Details

I. General information

NPI: 1982773735
Provider Name (Legal Business Name): KATHERINE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1264 S STATE ROAD 3
RUSHVILLE IN
46173-8509
US

IV. Provider business mailing address

1300 N MAIN ST
RUSHVILLE IN
46173-1116
US

V. Phone/Fax

Practice location:
  • Phone: 765-932-7591
  • Fax: 765-932-7576
Mailing address:
  • Phone: 765-932-4111
  • Fax: 765-932-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: