MEDICARE: MRS. BOBETTE S MARTIN M.A.,CCC-A

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	DA 898	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568465995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BOBETTE S MARTIN M.A.,CCC-A

Provider Business Mailing Address
First Line	:	5658 HIGHWAY 260
Second Line	:	STE 4
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5189
Country	:	US
Telephone Number	:	928-537-7373
Fax Number	:	928-537-7377

Provider Business Practice Location Address
First Line	:	5658 HIGHWAY 260
Second Line	:	STE 4
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5189
Country	:	US
Telephone Number	:	928-537-7373
Fax Number	:	928-537-7377

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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Directions to “ MRS. BOBETTE S MARTIN M.A.,CCC-A” Practice Location

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