Provider Demographics
NPI:1346373719
Name:MARTIN, KATINA LYNN (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:KATINA
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 MAPLE ST STE 17
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-4444
Mailing Address - Country:US
Mailing Address - Phone:802-352-9078
Mailing Address - Fax:802-352-9008
Practice Address - Street 1:111 MAPLE ST STE 17
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-4444
Practice Address - Country:US
Practice Address - Phone:802-352-9078
Practice Address - Fax:802-352-9008
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091-0000179171100000X
VT099-0000182175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist