Provider Demographics
NPI:1871052431
Name:DORING, MARTHA ANN
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:DORING
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 1:4867 APPLETREE LN
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9280
Mailing Address - Country:US
Mailing Address - Phone:989-686-6793
Mailing Address - Fax:
Practice Address - Street 1:4867 APPLETREE LN
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9280
Practice Address - Country:US
Practice Address - Phone:989-686-6793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIADC300650225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI26063690OtherBLUE CROSS