Healthcare Provider Details

I. General information

NPI: 1598987414
Provider Name (Legal Business Name): MARGARET MARTIN VINSEL MED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 WHITTINGTON PKWY STE 20
LOUISVILLE KY
40222-4925
US

IV. Provider business mailing address

312 WHITTINGTON PKWY STE 20
LOUISVILLE KY
40222-4925
US

V. Phone/Fax

Practice location:
  • Phone: 502-429-1249
  • Fax: 502-429-1255
Mailing address:
  • Phone: 502-429-1249
  • Fax: 502-429-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number200196900
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: