Provider Demographics
NPI:1114314911
Name:MARTIN, CARYN SUE (EDD)
Entity Type:Individual
Prefix:DR
First Name:CARYN
Middle Name:SUE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 OVERTURE WAY
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617-2387
Mailing Address - Country:US
Mailing Address - Phone:301-254-5300
Mailing Address - Fax:
Practice Address - Street 1:202 OVERTURE WAY
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2387
Practice Address - Country:US
Practice Address - Phone:301-254-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM00040225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist