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Individual

EMILY MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
4646 W JEFFERSON BLVD STE 100, FORT WAYNE, IN 46804-6832
(260) 436-0932
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
88000468A
IN

Other

Enumeration date
05/03/2017
Last updated
11/14/2018
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