Provider Demographics
NPI:1831713072
Name:MARTIN, BETHANY (TBVI, COMS)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:TBVI, COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8757 GEORGIA AVE STE 805
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3737
Mailing Address - Country:US
Mailing Address - Phone:240-737-5137
Mailing Address - Fax:
Practice Address - Street 1:8757 GEORGIA AVE STE 805
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3737
Practice Address - Country:US
Practice Address - Phone:240-737-5137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6700225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider