Provider Demographics
NPI:1295977551
Name:MARTEL, MICHAEL ROY
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROY
Last Name:MARTEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 COTTAGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-3910
Mailing Address - Country:US
Mailing Address - Phone:660-216-7082
Mailing Address - Fax:660-626-1439
Practice Address - Street 1:1300 COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-3910
Practice Address - Country:US
Practice Address - Phone:660-216-7082
Practice Address - Fax:660-626-1439
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012012817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty