Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | R1895 | KY |
N | 225XL0004X | Low Vision | R1895 | KY |
N | 225XM0800X | Mental Health | R1895 | KY |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | R1895 | KY |
N | 225XP0200X | Occupational Therapist - Pediatrics | R1895 | KY |
NPI | 1487927752 |
---|---|
Provider Name | Mrs. Jackie Lynn Martin |
First Address | Ashland, KY 41101-6822 |
Second Address | Ashland, KY 41101-3118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2012 |
Last Update Date | 17/02/2012 |