Provider Demographics
NPI:1447257944
Name:LAYNE, MARTY (AUD)
Entity type:Individual
Prefix:DR
First Name:MARTY
Middle Name:
Last Name:LAYNE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7701
Mailing Address - Country:US
Mailing Address - Phone:207-883-6466
Mailing Address - Fax:207-883-6556
Practice Address - Street 1:23 SPRING ST
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7701
Practice Address - Country:US
Practice Address - Phone:207-883-6466
Practice Address - Fax:207-883-6556
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP 55231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME009864Medicare PIN