Healthcare Provider Details

I. General information

NPI: 1346373719
Provider Name (Legal Business Name): KATINA LYNN MARTIN N.D., L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MAPLE ST STE 17
MIDDLEBURY VT
05753-4444
US

IV. Provider business mailing address

111 MAPLE ST STE 17
MIDDLEBURY VT
05753-4444
US

V. Phone/Fax

Practice location:
  • Phone: 802-352-9078
  • Fax: 802-352-9008
Mailing address:
  • Phone: 802-352-9078
  • Fax: 802-352-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number091-0000179
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099-0000182
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: