Healthcare Provider Details

I. General information

NPI: 1174300347
Provider Name (Legal Business Name): MARTHA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERRIMACK ST
LOWELL MA
01852-1708
US

IV. Provider business mailing address

100 MERRIMACK ST
LOWELL MA
01852-1708
US

V. Phone/Fax

Practice location:
  • Phone: 978-267-7661
  • Fax:
Mailing address:
  • Phone: 978-267-7661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: