Provider Demographics
NPI:1295237428
Name:MARTIN, DIANA LYNN (TVI)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:TVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:SHARON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13459-3710
Mailing Address - Country:US
Mailing Address - Phone:518-728-7176
Mailing Address - Fax:
Practice Address - Street 1:295 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:SHARON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:13459-3710
Practice Address - Country:US
Practice Address - Phone:518-728-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-04
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision