Provider Demographics
NPI:1770857815
Name:MARTIN, SHAINE CARRIE (AUD)
Entity Type:Individual
Prefix:
First Name:SHAINE
Middle Name:CARRIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3099 RIVER RD S
Mailing Address - Street 2:STE 200
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-9754
Mailing Address - Country:US
Mailing Address - Phone:503-485-2581
Mailing Address - Fax:503-485-2564
Practice Address - Street 1:21 EVERETT RD EXT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3357
Practice Address - Country:US
Practice Address - Phone:518-435-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter