Provider Demographics
NPI:1932940715
Name:MARTIN, MARION
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:MARTIN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 UPLAND RD
Mailing Address - Street 2:
Mailing Address - City:PLYMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:02367-1603
Mailing Address - Country:US
Mailing Address - Phone:781-422-4497
Mailing Address - Fax:
Practice Address - Street 1:16 MOON ISLAND RD
Practice Address - Street 2:
Practice Address - City:NORTH QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-1034
Practice Address - Country:US
Practice Address - Phone:617-453-9047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist