Provider Demographics
NPI:1154769263
Name:MARTIN, TATYANA NATASHA (MT-BC)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:NATASHA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 CAMBRIDGE BELTWAY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-3033
Mailing Address - Country:US
Mailing Address - Phone:412-216-6368
Mailing Address - Fax:
Practice Address - Street 1:1356 CAMBRIDGE BELTWAY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-3033
Practice Address - Country:US
Practice Address - Phone:412-216-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10729225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist