MEDICARE: EMILY E MARTIN LMT,CD(DONA),CCCE

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	225700000X	Massage Therapist	MT.0010069	CO

General Provider Information

NPI Number	:	1528401098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY E MARTIN LMT,CD(DONA),CCCE

Provider Business Mailing Address
First Line	:	2118 PHEASANT PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1824
Country	:	US
Telephone Number	:	719-460-1557
Fax Number	:

Provider Business Practice Location Address
First Line	:	2118 PHEASANT PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1824
Country	:	US
Telephone Number	:	719-460-1557
Fax Number	:

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

Provider Enumeration Date	:	04/15/2013
Last Update Date	:	06/05/2023

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