Provider Demographics
NPI:1659331353
Name:MARTIN, MELANIE M (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 REGENCY PARK DR
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-2248
Mailing Address - Country:US
Mailing Address - Phone:413-821-6988
Mailing Address - Fax:
Practice Address - Street 1:500 BEECH ST
Practice Address - Street 2:HOLYOKE HIGH SCHOOL
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2202
Practice Address - Country:US
Practice Address - Phone:413-493-1640
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer