Phillip Blair Martelly I

NPI #1265189526 in Brooklyn Center, Minnesota

Provider Information

NPI Number: 1265189526
Entity Type: Individual
Name: Phillip Blair Martelly I
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Mar 7, 2022
Last Updated: Mar 9, 2022

Practice Location

Address: 6701 PARKWAY CIR
City: Brooklyn Center
State: Minnesota
ZIP Code: 55430-2811
Phone: (612) 767-7222

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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