Provider Demographics
NPI:1023658424
Name:MARTIN, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 N 22ND WEST PL
Mailing Address - Street 2:
Mailing Address - City:SPERRY
Mailing Address - State:OK
Mailing Address - Zip Code:74073-4141
Mailing Address - Country:US
Mailing Address - Phone:928-727-2424
Mailing Address - Fax:
Practice Address - Street 1:9201 N 22ND WEST PL
Practice Address - Street 2:
Practice Address - City:SPERRY
Practice Address - State:OK
Practice Address - Zip Code:74073-4141
Practice Address - Country:US
Practice Address - Phone:928-727-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer