Provider Demographics
NPI:1235964594
Name:MARTINEZ-EPPERSON, MELINDA MARTY (MED)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:MARTY
Last Name:MARTINEZ-EPPERSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3253 W WILSON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4740
Mailing Address - Country:US
Mailing Address - Phone:312-783-2026
Mailing Address - Fax:
Practice Address - Street 1:3253 W WILSON AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-4740
Practice Address - Country:US
Practice Address - Phone:312-783-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist