Provider Demographics
NPI:1477882132
Name:MARTIN, MARY LOUISE (EMT-I)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LOUISE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:EMT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 PITTMAN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HEDWIG
Mailing Address - State:TX
Mailing Address - Zip Code:78152-3602
Mailing Address - Country:US
Mailing Address - Phone:210-667-1001
Mailing Address - Fax:
Practice Address - Street 1:3190 PITTMAN RD
Practice Address - Street 2:
Practice Address - City:SAINT HEDWIG
Practice Address - State:TX
Practice Address - Zip Code:78152-3602
Practice Address - Country:US
Practice Address - Phone:210-667-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36210146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36210OtherTEXAS DEPARTMENT OF HEALTH SERVICES