Provider Demographics
NPI:1235479932
Name:MARTIN, JOY R
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10002 S PULASKI RD
Mailing Address - Street 2:APT. 310
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4176
Mailing Address - Country:US
Mailing Address - Phone:708-724-6778
Mailing Address - Fax:
Practice Address - Street 1:10002 S PULASKI RD
Practice Address - Street 2:APT. 310
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4176
Practice Address - Country:US
Practice Address - Phone:708-724-6778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2512694222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist