MEDICARE: MICHAELA 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1972971570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA MARTIN

Provider Business Mailing Address
First Line	:	8428 SEWARDS BLUFF AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7373
Country	:	US
Telephone Number	:	702-628-6642
Fax Number	:

Provider Business Practice Location Address
First Line	:	6185 S PECOS RD STE 208
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3209
Country	:	US
Telephone Number	:	702-787-8762
Fax Number	:

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

Provider Enumeration Date	:	09/13/2015
Last Update Date	:	01/28/2016

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Directions to “ MICHAELA MARTIN ” Practice Location

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