MEDICARE: GEORGIA MARTIN SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	22006252A	IN

General Provider Information

NPI Number	:	1053854570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGIA MARTIN SLP

Provider Business Mailing Address
First Line	:	8937 SOUTHPOINTE DR STE A1
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-1087
Country	:	US
Telephone Number	:	317-851-8419
Fax Number	:	317-851-8499

Provider Business Practice Location Address
First Line	:	8937 SOUTHPOINTE DR STE A1
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-1087
Country	:	US
Telephone Number	:	317-851-8419
Fax Number	:	317-851-8499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	12/01/2016

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Directions to “ GEORGIA MARTIN SLP” Practice Location

Language	Start Address	Practice Location

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