Provider Demographics
NPI:1760829683
Name:MARTIN, MICHELLE K
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:K
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 1:1061B BUNARCH RD
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060-2440
Mailing Address - Country:US
Mailing Address - Phone:775-253-5260
Mailing Address - Fax:
Practice Address - Street 1:1061B BUNARCH RD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-2440
Practice Address - Country:US
Practice Address - Phone:775-253-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-01
Last Update Date:2013-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner