Healthcare Provider Details

I. General information

NPI: 1063960672
Provider Name (Legal Business Name): KAYLA MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E 8TH ST
PORT ANGELES WA
98362-6129
US

IV. Provider business mailing address

118 E 8TH ST
PORT ANGELES WA
98362-6129
US

V. Phone/Fax

Practice location:
  • Phone: 360-457-0431
  • Fax: 360-457-0493
Mailing address:
  • Phone: 360-457-0431
  • Fax: 360-457-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA61162433
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: