Provider Demographics
NPI:1063167633
Name:WEBB, MARTHA JULIET (CTRS)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:JULIET
Last Name:WEBB
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3485 LAUREL SPRINGS CV
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-3391
Mailing Address - Country:US
Mailing Address - Phone:334-507-8370
Mailing Address - Fax:
Practice Address - Street 1:3485 LAUREL SPRINGS CV
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-3391
Practice Address - Country:US
Practice Address - Phone:334-507-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61329225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist