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NPI Code Detail

MEDICARE: MRS. SAVANNAH LORAINE MARTIN

MEDICARE: MRS. SAVANNAH LORAINE 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
1106S00000XBehavior TechnicianRBT-25-436224FL

General Provider Information

NPI Number : 1679364095
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SAVANNAH LORAINE MARTIN
Provider Business Mailing Address
First Line : 6230 LAPIS LN
Second Line :
City : CRESTVIEW
State : FL
Zip : 32539-5425
Country : US
Telephone Number : 850-400-6098
Fax Number : 866-265-8817
Provider Business Practice Location Address
First Line : 1001 INDUSTRIAL DR
Second Line :
City : CRESTVIEW
State : FL
Zip : 32539-6943
Country : US
Telephone Number : 850-400-6098
Fax Number : 866-265-8817
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2025
Last Update Date : 05/15/2025

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Directions to “ MRS. SAVANNAH LORAINE MARTIN ” Practice Location

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