Provider Demographics
NPI:1255941167
Name:MARTIN, LAURIE ANN (CRC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:SLIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1142
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-1142
Mailing Address - Country:US
Mailing Address - Phone:603-566-5827
Mailing Address - Fax:
Practice Address - Street 1:6 CHADSWORTH CT
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-2425
Practice Address - Country:US
Practice Address - Phone:603-566-5827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Single Specialty