Provider Demographics
NPI:1568707974
Name:MAXEY, MARTIN WILLIAM (CMT, CMMP)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:WILLIAM
Last Name:MAXEY
Suffix:
Gender:M
Credentials:CMT, CMMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1185
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942-1185
Mailing Address - Country:US
Mailing Address - Phone:831-402-4903
Mailing Address - Fax:
Practice Address - Street 1:20 VIA CIMARRON
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4333
Practice Address - Country:US
Practice Address - Phone:831-402-4903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAMTC # 21525225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist