Healthcare Provider Details

I. General information

NPI: 1295307163
Provider Name (Legal Business Name): PAIGE MARTINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE NELSON

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 N MEADOWLARK WAY STE C&D
COEUR D ALENE ID
83815-5041
US

IV. Provider business mailing address

17731 FULLERFARM ST
NORTHRIDGE CA
91325-1312
US

V. Phone/Fax

Practice location:
  • Phone: 208-618-2593
  • Fax:
Mailing address:
  • Phone: 818-439-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: