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General NPI Number Information
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NPI Number | 1427318120
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Entity Type | Individual
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Provider Name | KIMBERLY ANNE MARTELL M.A.
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Gender | Female
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 1111 W 10TH ST # PBA212 1224
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-4800
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Country | US
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Telephone | 317-274-1224
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Fax |
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Provider Business Mailing Address
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Address Line | 128 MONROE ST
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City | BALL
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State | LA
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Zip | 71405-3728
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Country | US
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Telephone | 318-229-1259
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 390200000X.
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License Number State |
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