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NPI Code Detail

MEDICARE: CHARLOTTE MARIE MARTIN

MEDICARE: CHARLOTTE MARIE MARTIN
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
1225X00000XOccupational Therapist

General Provider Information

NPI Number : 1457013922
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLOTTE MARIE MARTIN
Provider Business Mailing Address
First Line : 5095 HAMMOCK DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818-8570
Country : US
Telephone Number : 615-772-7072
Fax Number :
Provider Business Practice Location Address
First Line : 3731 W COOK RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818-9662
Country : US
Telephone Number : 317-204-3736
Fax Number : 317-449-5783
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2021
Last Update Date : 10/12/2021

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Directions to “ CHARLOTTE MARIE MARTIN ” Practice Location

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