MEDICARE: MS. ANITA MARTIN MSP CCCSLP

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	235Z00000X	Speech-Language Pathologist	SP0000003372	TN

General Provider Information

NPI Number	:	1184766651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANITA MARTIN MSP CCCSLP

Provider Business Mailing Address
First Line	:	1000 WORTHINGTON TRAIL
Second Line	:	APT 14206
City	:	SPRING HILL
State	:	TN
Zip	:	37174
Country	:	US
Telephone Number	:	931-334-5456
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 N JACKSON ST
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-2208
Country	:	US
Telephone Number	:	931-455-5189
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	05/10/2017

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