MEDICARE: ELIZABETH J MARTIN

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1659172336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH J MARTIN

Provider Business Mailing Address
First Line	:	1102 BEDFORD CHAPEL RD
Second Line	:
City	:	MILTON
State	:	WV
Zip	:	25541-6647
Country	:	US
Telephone Number	:	336-633-9985
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 BEDFORD CHAPEL RD
Second Line	:
City	:	MILTON
State	:	WV
Zip	:	25541-6647
Country	:	US
Telephone Number	:	336-633-9985
Fax Number	:

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

Provider Enumeration Date	:	03/20/2025
Last Update Date	:	03/20/2025

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