MEDICARE: DR. JENNIFER MARTIN AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist

General Provider Information

NPI Number	:	1013461532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER MARTIN AU.D.

Provider Business Mailing Address
First Line	:	377 PLANTATION ST
Second Line	:	AUDIOLOGY (126)
City	:	WORCESTER
State	:	MA
Zip	:	01605-2300
Country	:	US
Telephone Number	:	413-584-4040
Fax Number	:

Provider Business Practice Location Address
First Line	:	377 PLANTATION ST
Second Line	:	AUDIOLOGY (126)
City	:	WORCESTER
State	:	MA
Zip	:	01605-2300
Country	:	US
Telephone Number	:	413-584-4040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2016
Last Update Date	:	01/26/2017

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