Provider Demographics
NPI:1447589908
Name:O'CONNOR, MARTINE CLAUDE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARTINE
Middle Name:CLAUDE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8126 SW YACHTSMANS DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-4837
Mailing Address - Country:US
Mailing Address - Phone:561-254-2173
Mailing Address - Fax:
Practice Address - Street 1:8126 SW YACHTSMANS DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-4837
Practice Address - Country:US
Practice Address - Phone:561-254-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-12
Last Update Date:2009-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMCPO4996Medicaid