Provider Demographics
NPI:1336832088
Name:MARTIN, MARGARET SUSAN (OWNER)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:SUSAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17025 NE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2608
Mailing Address - Country:US
Mailing Address - Phone:206-914-7500
Mailing Address - Fax:
Practice Address - Street 1:7903 170TH PL NE APT 304
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4432
Practice Address - Country:US
Practice Address - Phone:206-914-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604618772251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health