MEDICARE: KATRINA MARTIR M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	000079941	KY
2	222Q00000X	Developmental Therapist	000079941	KY

General Provider Information

NPI Number	:	1013266139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA MARTIR M.A.

Provider Business Mailing Address
First Line	:	160 SMITH BALLARD ST
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2148
Country	:	US
Telephone Number	:	859-625-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 SMITH BALLARD ST
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2148
Country	:	US
Telephone Number	:	859-625-2900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	01/23/2015

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