MEDICARE: MRS. CARRIE C MARTINSON OTR/L

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	174400000X	Specialist	417	NE

General Provider Information

NPI Number	:	1639449333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE C MARTINSON OTR/L

Provider Business Mailing Address
First Line	:	921 P ST
Second Line	:	PO BOX 325
City	:	BRIDGEPORT
State	:	NE
Zip	:	69336-0325
Country	:	US
Telephone Number	:	308-262-0210
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 S ST
Second Line	:
City	:	BRIDGEPORT
State	:	NE
Zip	:	69336-0579
Country	:	US
Telephone Number	:	308-262-1600
Fax Number	:

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

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	01/11/2012

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Directions to “ MRS. CARRIE C MARTINSON OTR/L” Practice Location

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