MEDICARE: MRS. SHANTIMOL 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
1	225700000X	Massage Therapist	MT024109	TX

General Provider Information

NPI Number	:	1881858942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANTIMOL MARTIN

Provider Business Mailing Address
First Line	:	7139 BELLAIRE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-3505
Country	:	US
Telephone Number	:	713-779-7139
Fax Number	:

Provider Business Practice Location Address
First Line	:	7139 BELLAIRE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-3505
Country	:	US
Telephone Number	:	713-779-7139
Fax Number	:

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

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/17/2008

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Directions to “ MRS. SHANTIMOL MARTIN ” Practice Location

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