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General NPI Number Information
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NPI Number | 1902489685
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Entity Type | Individual
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Provider Name | OLIVIA MARTIN M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 317 NW GILMAN BLVD STE 50
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City | ISSAQUAH
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State | WA
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Zip | 98027-2485
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Country | US
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Telephone | 206-799-7831
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Fax |
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Provider Business Mailing Address
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Address Line | 812 5TH AVE N APT 102
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City | SEATTLE
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State | WA
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Zip | 98109-6121
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Country | US
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Telephone | 971-409-0560
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | LL61164516
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License Number State | WA
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