Provider Demographics
NPI:1639449333
Name:MARTINSON, CARRIE C (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:C
Last Name:MARTINSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 P ST
Mailing Address - Street 2:PO BOX 325
Mailing Address - City:BRIDGEPORT
Mailing Address - State:NE
Mailing Address - Zip Code:69336-0325
Mailing Address - Country:US
Mailing Address - Phone:308-262-0210
Mailing Address - Fax:
Practice Address - Street 1:1313 S ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:NE
Practice Address - Zip Code:69336-0579
Practice Address - Country:US
Practice Address - Phone:308-262-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE417174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist