Provider Demographics
NPI:1083976112
Name:MARTIN, MARION KATHLEEN (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:KATHLEEN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:MARION
Other - Middle Name:KATHLEEN
Other - Last Name:BLUESTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2542 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2560
Mailing Address - Country:US
Mailing Address - Phone:812-590-4843
Mailing Address - Fax:
Practice Address - Street 1:2542 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2560
Practice Address - Country:US
Practice Address - Phone:812-590-4843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101739231H00000X
KY100547237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist