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General NPI Number Information
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NPI Number | 1225835879
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Entity Type | Individual
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Provider Name | MARTHA YOUNGS
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Gender |
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 23348 FARMINGTON RD
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City | FARMINGTON
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State | MI
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Zip | 48336-3102
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Country | US
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Telephone | 248-477-3033
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Fax |
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Provider Business Mailing Address
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Address Line | 2326 PEPPERIDGE TRL
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City | BRIGHTON
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State | MI
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Zip | 48114-8953
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Country | US
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Telephone | 248-794-2372
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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 | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | BSNIJ88SLC
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License Number State | MI
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