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NPI Code Detail

MEDICARE: CASSIDY MARTINEZ RBT

MEDICARE: CASSIDY MARTINEZ RBT
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
1106S00000XBehavior TechnicianRBT-24-8360-743243IL

General Provider Information

NPI Number : 1235975822
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIDY MARTINEZ RBT
Provider Business Mailing Address
First Line : 1240 CHALET RD APT 303
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-8964
Country : US
Telephone Number : 331-250-9926
Fax Number :
Provider Business Practice Location Address
First Line : 2801 W HOWARD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60645-1228
Country : US
Telephone Number : 773-305-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2024
Last Update Date : 07/03/2024

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Directions to “ CASSIDY MARTINEZ RBT” Practice Location

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