Provider Demographics
NPI:1366624157
Name:CALLIHAM, MARTHA B (LAC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:B
Last Name:CALLIHAM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MARTY
Other - Middle Name:
Other - Last Name:CALLIHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:2919 MANCHACA RD
Mailing Address - Street 2:SUITE 104-A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4817
Mailing Address - Country:US
Mailing Address - Phone:512-416-7600
Mailing Address - Fax:512-416-7600
Practice Address - Street 1:2919 MANCHACA RD
Practice Address - Street 2:SUITE 104-A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4817
Practice Address - Country:US
Practice Address - Phone:512-416-7600
Practice Address - Fax:512-416-7600
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00422171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist