Provider Demographics
NPI:1528401098
Name:MARTIN, EMILY E (LMT,CD(DONA),CCCE)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMT,CD(DONA),CCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 PHEASANT PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1824
Mailing Address - Country:US
Mailing Address - Phone:719-460-1557
Mailing Address - Fax:
Practice Address - Street 1:2118 PHEASANT PL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1824
Practice Address - Country:US
Practice Address - Phone:719-460-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0010069225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty