Provider Demographics
NPI:1851124291
Name:MARTIN, NICOLE CHRISTINE (LMT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:CHRISTINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:CHRISTINE
Other - Last Name:PUTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-1037
Mailing Address - Country:US
Mailing Address - Phone:269-414-8902
Mailing Address - Fax:
Practice Address - Street 1:705 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-1037
Practice Address - Country:US
Practice Address - Phone:269-414-8902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501011952225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist