Provider Demographics
NPI:1629479274
Name:ASSISTIVE TECHNOLOGY INITIATIVES
Entity Type:Organization
Organization Name:ASSISTIVE TECHNOLOGY INITIATIVES
Other - Org Name:ATI
Other - Org Type:Other Name
Authorized Official - Title/Position:SLP/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:I
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:505-330-6443
Mailing Address - Street 1:612 LITTLE RABBIT
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-3108
Mailing Address - Country:US
Mailing Address - Phone:505-330-6443
Mailing Address - Fax:
Practice Address - Street 1:612 LITTLE RABBIT
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-3108
Practice Address - Country:US
Practice Address - Phone:505-330-6443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1429235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty