Provider Demographics
NPI:1376806786
Name:MARTINS, ANDRESSA OLIVEIRA (ATC)
Entity Type:Individual
Prefix:MISS
First Name:ANDRESSA
Middle Name:OLIVEIRA
Last Name:MARTINS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 MYRTLE GREENS DR
Mailing Address - Street 2:APT E
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9016
Mailing Address - Country:US
Mailing Address - Phone:843-349-2823
Mailing Address - Fax:
Practice Address - Street 1:935 ONE LANDON LOOP
Practice Address - Street 2:COASTAL CAROLINA UNIVERSITY
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526
Practice Address - Country:US
Practice Address - Phone:843-349-2823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1026921732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer