Provider Demographics
NPI:1518488352
Name:PARKER A. MARTIN, PA
Entity Type:Organization
Organization Name:PARKER A. MARTIN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PARKER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARTIN,M.S., CCC-SLP
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:954-249-2430
Mailing Address - Street 1:PO BOX 23956
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33307
Mailing Address - Country:US
Mailing Address - Phone:954-249-2430
Mailing Address - Fax:954-947-6199
Practice Address - Street 1:4500 NORTH FEDERAL HWY
Practice Address - Street 2:APT 318B
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-249-2430
Practice Address - Fax:954-947-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-01
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLSA15518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022603800Medicaid
FL018911400Medicaid
FLSA15518OtherSPEECH LANGUAGE PATHOLOGIST