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Individual
MARY BETH MUCKLOW
Active
Individual
MARY BETH MUCKLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0520
KY
207Y00000X
Otolaryngology Physician
0520
KY
231H00000X
Audiologist
Primary
23002305A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200937310
—
IN
Enumeration date
02/29/2008
Last updated
11/15/2022
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