Provider Demographics
NPI:1114275120
Name:MARTIN, BARBARA R (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16916 HARRIERRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-5826
Mailing Address - Country:US
Mailing Address - Phone:813-504-7228
Mailing Address - Fax:
Practice Address - Street 1:16916 HARRIERRIDGE PL
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-5826
Practice Address - Country:US
Practice Address - Phone:813-504-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-22
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist