1386219608 NPI number — TEAGAN S MARTEL MSW

Table of content: TEAGAN S MARTEL MSW (NPI 1386219608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386219608 NPI number — TEAGAN S MARTEL MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTEL
Provider First Name:
TEAGAN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386219608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
356 VT ROUTE 14
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST CALAIS
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05650-8271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-793-7546
Provider Business Mailing Address Fax Number:
802-225-6090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
356 VT ROUTE 14
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST CALAIS
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05650-8271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-793-7546
Provider Business Practice Location Address Fax Number:
802-225-6090
Provider Enumeration Date:
05/20/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  097.0134428 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 097.0134428 . This is a "VERMONT REGISTRATION, NONLICENSED" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".