Provider Demographics
NPI:1578282224
Name:MARTIN, KAITLYN CHRISTINE (BA)
Entity Type:Individual
Prefix:MISS
First Name:KAITLYN
Middle Name:CHRISTINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22433 NE MARKETPLACE DR APT J2066
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-1922
Mailing Address - Country:US
Mailing Address - Phone:623-313-8005
Mailing Address - Fax:
Practice Address - Street 1:2002 156TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3827
Practice Address - Country:US
Practice Address - Phone:800-682-6934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program