Provider Demographics
NPI:1467911875
Name:MARTIN, ABBEY
Entity Type:Individual
Prefix:
First Name:ABBEY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30373 398TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAGNER
Mailing Address - State:SD
Mailing Address - Zip Code:57380-7213
Mailing Address - Country:US
Mailing Address - Phone:605-491-3294
Mailing Address - Fax:
Practice Address - Street 1:740 E LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE ANDES
Practice Address - State:SD
Practice Address - Zip Code:57356-2001
Practice Address - Country:US
Practice Address - Phone:605-384-3661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD282A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant