Provider Demographics
NPI:1134556996
Name:MARTIN, MIA COURTNEY (MS)
Entity type:Individual
Prefix:MRS
First Name:MIA
Middle Name:COURTNEY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 SAWMILL TRACE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4860
Mailing Address - Country:US
Mailing Address - Phone:301-803-9465
Mailing Address - Fax:
Practice Address - Street 1:4005 SAWMILL TRACE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4860
Practice Address - Country:US
Practice Address - Phone:301-803-9465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist