Provider Demographics
NPI:1558864926
Name:MARTIN, KATHY ANN (MSAC, LAC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSAC, LAC
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:ANN
Other - Last Name:HOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:608 BARNEGAT BLVD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08722-4106
Mailing Address - Country:US
Mailing Address - Phone:848-333-5610
Mailing Address - Fax:
Practice Address - Street 1:175 GUNNING RIVER RD
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-1436
Practice Address - Country:US
Practice Address - Phone:609-660-6002
Practice Address - Fax:609-660-0003
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00129700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty