Provider Demographics
NPI:1821005489
Name:MARTIN, EDITH ANNELIESE (NCLMT)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:ANNELIESE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NCLMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:164 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2349
Mailing Address - Country:US
Mailing Address - Phone:931-636-0885
Mailing Address - Fax:931-967-9050
Practice Address - Street 1:164 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2349
Practice Address - Country:US
Practice Address - Phone:931-636-0885
Practice Address - Fax:931-967-9050
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4767225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist