Provider Demographics
NPI:1902927700
Name:KNAUER, MARTA KAY
Entity Type:Individual
Prefix:MS
First Name:MARTA
Middle Name:KAY
Last Name:KNAUER
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 1:2416 N D ST
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-1647
Mailing Address - Country:US
Mailing Address - Phone:765-552-5533
Mailing Address - Fax:765-552-9254
Practice Address - Street 1:2416 N D ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-1647
Practice Address - Country:US
Practice Address - Phone:765-552-5533
Practice Address - Fax:765-552-9254
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities