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NPI Code Detail

MEDICARE: MS. MARTHA MARIN O'BRYAN M.S.

MEDICARE: MS. MARTHA MARIN O'BRYAN M.S.
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
1235Z00000XSpeech-Language PathologistSLP0719AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1SLP0719OTHERAZSTATE LICENSE-SLP

General Provider Information

NPI Number : 1912043332
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARTHA MARIN O'BRYAN M.S.
Provider Business Mailing Address
First Line : 721 W WILSHIRE DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85007-1312
Country : US
Telephone Number : 602-589-1001
Fax Number : 602-589-0140
Provider Business Practice Location Address
First Line : 4510 N 37TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85019-3206
Country : US
Telephone Number : 602-336-2990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 07/08/2007

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