=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407669005
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARA GABLE MARTIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2025
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 N ROYAL AVE STE B
-----------------------------------------------------
City | EVANSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47715-7845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-269-5643
-----------------------------------------------------
Fax | 812-496-0418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 90 HOWARD DR
-----------------------------------------------------
City | SHELBYVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40065-8138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-269-5643
-----------------------------------------------------
Fax | 812-496-0418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 297562
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 31008641A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------