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General NPI Number Information
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NPI Number | 1679364095
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Entity Type | Individual
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Provider Name | MRS. SAVANNAH LORAINE MARTIN
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Gender | Female
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 1001 INDUSTRIAL DR
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City | CRESTVIEW
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State | FL
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Zip | 32539-6943
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Country | US
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Telephone | 850-400-6098
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Fax | 866-265-8817
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Provider Business Mailing Address
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Address Line | 6230 LAPIS LN
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City | CRESTVIEW
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State | FL
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Zip | 32539-5425
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Country | US
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Telephone | 850-400-6098
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Fax | 866-265-8817
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-436224
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License Number State | FL
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