Provider Demographics
NPI:1053058313
Name:CASWELL, MARTHA GAIL
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:GAIL
Last Name:CASWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 STONE AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2629
Mailing Address - Country:US
Mailing Address - Phone:859-953-5312
Mailing Address - Fax:
Practice Address - Street 1:229 STONE AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2629
Practice Address - Country:US
Practice Address - Phone:859-953-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist