Provider Demographics
NPI:1871845602
Name:MARTIN TRASK, TAMMY LYNN
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LYNN
Last Name:MARTIN TRASK
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 1:233 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILO
Mailing Address - State:ME
Mailing Address - Zip Code:04463
Mailing Address - Country:US
Mailing Address - Phone:207-943-6082
Mailing Address - Fax:207-943-5626
Practice Address - Street 1:94 PARK ST.
Practice Address - Street 2:
Practice Address - City:MILO
Practice Address - State:ME
Practice Address - Zip Code:04463
Practice Address - Country:US
Practice Address - Phone:207-943-6082
Practice Address - Fax:207-943-5626
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility