MEDICARE: MRS. MARGARET (PEGGY) JOSEPHINE MARTIN-BUNTING MA SPEECH THERAPY

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	SLP6146	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	#SLP6146	OTHER	AZ	SPEECH LANGUAGE PATHOLOGIST

General Provider Information

NPI Number	:	1598998163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARGARET (PEGGY) JOSEPHINE MARTIN-BUNTING MA SPEECH THERAPY

Provider Business Mailing Address
First Line	:	2922 ECLAIRE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032
Country	:	US
Telephone Number	:	602-790-0358
Fax Number	:	602-283-5326

Provider Business Practice Location Address
First Line	:	2922 E CLAIRE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-5015
Country	:	US
Telephone Number	:	602-790-0358
Fax Number	:	602-283-5326

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

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	08/31/2009

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