Provider Demographics
NPI:1487327805
Name:MARTINEZ, KAYLA MICHELLE (PTA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MICHELLE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:MICHELLE
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:98 BANGOR ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1603
Mailing Address - Country:US
Mailing Address - Phone:207-521-0200
Mailing Address - Fax:207-521-0210
Practice Address - Street 1:98 BANGOR ST STE A
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1603
Practice Address - Country:US
Practice Address - Phone:207-521-0200
Practice Address - Fax:207-521-0210
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA5997225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant