Individual
STACEY LOUISE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1061 OGDEN FARM RD, MOOREFIELD, WV 26836-9012
(304) 703-2917
Mailing address
1061 OGDEN FARM RD, MOOREFIELD, WV 26836-9012
(304) 703-2917
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
WV
Other
Enumeration date
07/17/2024
Last updated
07/17/2024
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