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General NPI Number Information
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NPI Number | 1679298012
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Entity Type | Individual
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Provider Name | ASHLEY MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 10/07/2022
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 299 HALLOCK AVE
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1217
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Country | US
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Telephone | 631-473-4284
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Fax |
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Provider Business Mailing Address
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Address Line | 24 DOUGLASS ST
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City | BRENTWOOD
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State | NY
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Zip | 11717-1811
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Country | US
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Telephone | 631-748-0996
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 235500000X
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Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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