Provider Demographics
NPI:1801291364
Name:MARTIN, ASHLEE
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:
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 1:39 KENNEDY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1957
Mailing Address - Country:US
Mailing Address - Phone:860-963-2174
Mailing Address - Fax:860-963-2178
Practice Address - Street 1:39 KENNEDY DR
Practice Address - Street 2:SUITE A
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1957
Practice Address - Country:US
Practice Address - Phone:860-963-2174
Practice Address - Fax:860-963-2178
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1511225200000X
RIPTA00997225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant