MEDICARE: ANGELA M. TOMLIN, PH.D.

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	103T00000X	Psychologist	20040448A	IN

General Provider Information

NPI Number	:	1174794812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELA M. TOMLIN, PH.D.

Provider Business Mailing Address
First Line	:	470 W MAIN ST
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-3115
Country	:	US
Telephone Number	:	317-439-8567
Fax Number	:	317-885-9566

Provider Business Practice Location Address
First Line	:	470 W MAIN ST
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-3115
Country	:	US
Telephone Number	:	317-439-8567
Fax Number	:	317-885-9566

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANGELA MARIE TOMLIN
Credential	:	PHD
Telephone Number	:	317-439-8567

Provider Enumeration Date	:	03/21/2008
Last Update Date	:	03/21/2008

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