Provider Demographics
NPI:1932522992
Name:MARTIN, KATHRYN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:143 FOREST VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3545 CARVER SCHOOL RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-4033
Practice Address - Country:US
Practice Address - Phone:704-918-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer