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General NPI Number Information
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NPI Number | 1821889627
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Entity Type | Individual
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Provider Name | KRISTINA MARYE BUCKEL
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Gender | Female
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 6161 HILLSIDE AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-2596
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Country | US
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Telephone | 888-717-5835
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Fax |
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Provider Business Mailing Address
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Address Line | 5541 HILL RISE DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-2148
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Country | US
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Telephone | 317-828-8810
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-21-186006
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License Number State |
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