Provider Demographics
NPI:1245507565
Name:MARTIN, KELSEY RENEE (CPM)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:RENEE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:RENEE
Other - Last Name:HOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPM
Mailing Address - Street 1:13315 ROUTE 35 S
Mailing Address - Street 2:
Mailing Address - City:MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17058-7228
Mailing Address - Country:US
Mailing Address - Phone:717-436-9804
Mailing Address - Fax:
Practice Address - Street 1:13315 ROUTE 35 S
Practice Address - Street 2:
Practice Address - City:MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:17058-7228
Practice Address - Country:US
Practice Address - Phone:717-436-9804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay