Provider Demographics
NPI:1821490418
Name:MARTIN, LORI ANN (HIS)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 WALTER DR
Mailing Address - Street 2:SUIT 2
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-7482
Mailing Address - Country:US
Mailing Address - Phone:570-523-5023
Mailing Address - Fax:
Practice Address - Street 1:135 WALTER DR
Practice Address - Street 2:SUIT 2
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-7482
Practice Address - Country:US
Practice Address - Phone:570-523-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03505237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF03505OtherDEPARTMENT OF HEALTH-FITTER