Provider Demographics
NPI:1164826335
Name:MARTIN, COLLEEN
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MARTIN
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 1:12240 BOWMAR CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-9460
Mailing Address - Country:US
Mailing Address - Phone:775-825-9995
Mailing Address - Fax:775-825-9877
Practice Address - Street 1:4600 KIETZKE LN
Practice Address - Street 2:SUITE O-260
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5033
Practice Address - Country:US
Practice Address - Phone:775-825-9995
Practice Address - Fax:775-825-9877
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner