Provider Demographics
NPI:1841403128
Name:MARTIN, ANALICIA KELLY (MA, ATC)
Entity Type:Individual
Prefix:MS
First Name:ANALICIA
Middle Name:KELLY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 GLACIER WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-5210
Mailing Address - Country:US
Mailing Address - Phone:925-580-5521
Mailing Address - Fax:
Practice Address - Street 1:607 GLACIER WAY
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-5210
Practice Address - Country:US
Practice Address - Phone:925-580-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer