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General NPI Number Information
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NPI Number | 1215390547
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Entity Type | Individual
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Provider Name | SHELBY N MARTIN MS, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 12/04/2018
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Provider Practice Location Address
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Address Line | 1700 DOGWOOD MILE ST
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City | LAURINBURG
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State | NC
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Zip | 28352-5521
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Country | US
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Telephone | 704-254-3312
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Fax |
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Provider Business Mailing Address
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Address Line | 1815 G B HILL RD
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City | MONROE
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State | NC
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Zip | 28110-7587
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Country | US
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Telephone | 704-254-3312
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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 | LAT-3312
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License Number State | NC
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