Provider Demographics
NPI:1710747225
Name:MARTIN, KAYLA
Entity Type:Individual
Prefix:
First Name:KAYLA
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 1:57 OLD FERRY RD
Mailing Address - Street 2:
Mailing Address - City:DEER ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04627-3330
Mailing Address - Country:US
Mailing Address - Phone:508-577-2057
Mailing Address - Fax:
Practice Address - Street 1:57 OLD FERRY RD
Practice Address - Street 2:
Practice Address - City:DEER ISLE
Practice Address - State:ME
Practice Address - Zip Code:04627-3330
Practice Address - Country:US
Practice Address - Phone:508-577-2057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP3886235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist