Individual
BENJAMIN JOHN FAULSTICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2420 WILSON AVE, MADISON, IN 47250-2135
(812) 265-8226
(812) 265-8227
Mailing address
2420 WILSON AVE, MADISON, IN 47250-2135
(812) 265-8226
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
222Q00000X
INDIANA FIRST STEPS
IN
Enumeration date
07/02/2019
Last updated
07/03/2019
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