Provider Demographics
NPI:1588201941
Name:MARTIN, SHELBY
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 N YATES ST # 161
Mailing Address - Street 2:
Mailing Address - City:PEWAMO
Mailing Address - State:MI
Mailing Address - Zip Code:48873-5132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:252 N YATES ST # 161
Practice Address - Street 2:
Practice Address - City:PEWAMO
Practice Address - State:MI
Practice Address - Zip Code:48873-5132
Practice Address - Country:US
Practice Address - Phone:517-214-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer