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General NPI Number Information
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NPI Number | 1386208726
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Entity Type | Individual
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Provider Name | CASSIDY MARTIN M.S. CF-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 1902 59TH ST W
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City | BRADENTON
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State | FL
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Zip | 34209-4602
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Country | US
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Telephone | 941-761-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 5680 FOUNTAIN LAKE CIR APT 105
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City | BRADENTON
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State | FL
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Zip | 34207-3756
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Country | US
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Telephone | 618-384-7261
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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 | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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