=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891639324
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA MARTIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2026
-----------------------------------------------------
Last Update Date | 04/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 123 DWIGHT RD
-----------------------------------------------------
City | LONGMEADOW
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01106-1993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-454-8445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 GATES AVE
-----------------------------------------------------
City | EAST LONGMEADOW
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01028-1141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 17063
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------