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NPI Code Detail

MEDICARE: MADELYN WARNOCK MS ED

MEDICARE: MADELYN WARNOCK MS ED
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
1222Q00000XDevelopmental TherapistIN

General Provider Information

NPI Number : 1063989838
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELYN WARNOCK MS ED
Provider Business Mailing Address
First Line : ATTN: MADELYN 'MEG' WARNOCK
Second Line : 2 N MERIDIAN STREET
City : INDIANAPOLIS
State : IN
Zip : 46204
Country : US
Telephone Number : 317-550-1978
Fax Number :
Provider Business Practice Location Address
First Line : 1200 E 42ND ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46205-2004
Country : US
Telephone Number : 317-550-1978
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2018
Last Update Date : 10/30/2018

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