MEDICARE: KORIN DEE MARTINEK

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	225700000X	Massage Therapist	7501013080	MI

General Provider Information

NPI Number	:	1508472101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORIN DEE MARTINEK

Provider Business Mailing Address
First Line	:	3337 S AIRPORT RD W
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7927
Country	:	US
Telephone Number	:	231-421-5213
Fax Number	:	231-421-5215

Provider Business Practice Location Address
First Line	:	3337 S AIRPORT RD W
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7927
Country	:	US
Telephone Number	:	231-421-5213
Fax Number	:	231-421-5215

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

Provider Enumeration Date	:	09/18/2020
Last Update Date	:	09/18/2020

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Directions to “ KORIN DEE MARTINEK ” Practice Location

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