Individual
AUDREY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PRS
Contact information
Practice address
1003 PARK ST, OGDENSBURG, NY 13669-3911
(315) 713-9090
Mailing address
204 NEW CONNECTICUT RD, THERESA, NY 13691-4202
(315) 816-1947
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/13/2023
Last updated
07/13/2023
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