Provider Demographics
NPI:1245051267
Name:MARTIN, KATELYN JOSEPHINE
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:JOSEPHINE
Last Name:MARTIN
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 1:226 N MIDVALE BLVD APT 306
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-5006
Mailing Address - Country:US
Mailing Address - Phone:720-878-8721
Mailing Address - Fax:
Practice Address - Street 1:226 N MIDVALE BLVD APT 306
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-5006
Practice Address - Country:US
Practice Address - Phone:720-878-8721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer