Provider Demographics
NPI:1578336863
Name:MARTIN, MAKAYLA ROSE (RBT)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:ROSE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1250 LAMOILLE HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-4397
Mailing Address - Country:US
Mailing Address - Phone:775-777-1292
Mailing Address - Fax:775-777-1293
Practice Address - Street 1:1250 LAMOILLE HWY STE 103
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4397
Practice Address - Country:US
Practice Address - Phone:177-593-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVRBT3837106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician