Provider Demographics
NPI:1811514318
Name:MARTZ, KATHRYN (MSED)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MARTZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:3908 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2103
Mailing Address - Country:US
Mailing Address - Phone:516-557-6298
Mailing Address - Fax:
Practice Address - Street 1:3908 CLARK ST
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2103
Practice Address - Country:US
Practice Address - Phone:516-557-6298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist