Provider Demographics
NPI:1235396367
Name:MARTIN, CARRIE A (SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4654 ANGLER CIR
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-1900
Mailing Address - Country:US
Mailing Address - Phone:405-315-4510
Mailing Address - Fax:
Practice Address - Street 1:4654 ANGLER CIR
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-1900
Practice Address - Country:US
Practice Address - Phone:405-315-4510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist