Provider Demographics
NPI:1720558935
Name:MARTIN, NICOLE P
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:P
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:P
Other - Last Name:ALSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3011 N CENTER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-3149
Mailing Address - Country:US
Mailing Address - Phone:810-736-0600
Mailing Address - Fax:
Practice Address - Street 1:3011 N CENTER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-3149
Practice Address - Country:US
Practice Address - Phone:810-736-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006059225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology