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General NPI Number Information
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NPI Number | 1073026589
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Entity Type | Individual
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Provider Name | RAITHEL JEAN MARTIN MSE, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 405 NW 3RD ST
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City | ANDREWS
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State | TX
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Zip | 79714-5014
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Country | US
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Telephone | 432-523-3640
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Fax |
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Provider Business Mailing Address
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Address Line | 6610 N LOVINGTON HWY
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City | HOBBS
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State | NM
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Zip | 88240-9120
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Country | US
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Telephone | 210-213-0147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT7439
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License Number State | TX
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