Healthcare Provider Details

I. General information

NPI: 1437509213
Provider Name (Legal Business Name): LENORE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 MILL ST SUITE B
WORCESTER MA
01602-3191
US

IV. Provider business mailing address

44 HICKORY DR
WORCESTER MA
01609-1016
US

V. Phone/Fax

Practice location:
  • Phone: 508-752-8466
  • Fax:
Mailing address:
  • Phone: 508-735-7145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255R0406X
TaxonomyBlind Rehabilitation Specialist/Technologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: