KELLY RAE MARTIN (NPI# 1477117885) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477117885 |
| Entity Type | Individual |
| Full Name | KELLY RAE MARTIN |
| Practice Address |
13881 Schuelke Beach Rd Nw Miltona MN 56354 |
| Mailing Address |
13881 Schuelke Beach Rd Nw Miltona MN 56354-8300 |
| Practice Telephone | 2186391843 |
| Mailing Telephone | 2186391843 |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2019-05-01 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578100111 | Kelly Martin | Speech-Language Pathologist | 948 Dinosaur Dr, Erie, CO 80516-6576 | 2019-12-02 |
| 1386298677 | Kelly Marie Martin | Licensed Practical Nurse | 909 S Michael St, Saint Marys, PA 15857-3030 | 2019-07-25 |
| 1679098727 | Kelly Lynn Martin | Massage Therapist | 6537 Fairlane Dr, Boston, NY 14025-9637 | 2017-08-10 |
| 1891231379 | Kelly Martin | Speech-Language Pathologist | 3513 Indian Oaks Ln, Toledo, OH 43617-3007 | 2017-01-09 |
| 1376900654 | Kelly Ann Martin | Counselor | 5501 Pandale Valley Dr, Mckinney, TX 75071-7721 | 2016-01-18 |
| 1245616481 | Kelly A Martin | Counselor | 8180 Eagle Mountain Cir, Fort Worth, TX 76135-9531 | 2015-08-10 |
| 1316330178 | Kelly Martin | Rehabilitation Practitioner | 12111 N 66th Ave, Glendale, AZ 85304-1625 | 2015-03-17 |
| 1538563077 | Kelly Ann Martin | Counselor | 15208 County Road 1835, Lubbock, TX 79424-8520 | 2014-10-13 |
| 1124430764 | Kelly Michael Martin | Registered Nurse | 1001 S. Gearge St, York, PA 17403 | 2014-06-02 |
| 1205266277 | Kelly Martin | Social Worker | 110 N. Fouth Avenue, Ann Arbor, MI 48107 | 2013-11-12 |
| Street Address |
13881 SCHUELKE BEACH RD NW |
| City | MILTONA |
| State | MN |
| Zip Code | 56354 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811535347 | Shannon Marie Leininger | Nurse Practitioner | 199 Pine Ave, Miltona, MN 56354-4505 | 2019-12-16 |
| 1881237998 | Sharon M Bridges | Physical Therapist | 755 County Road 14 Ne, Miltona, MN 56354-8150 | 2019-10-21 |
| 1033739925 | Jeremiah Ryan Shuck | Student in an Organized Health Care Education/Training Program | 3251 Basswood Shores Ln Nw, Miltona, MN 56354-8303 | 2020-04-21 |
| 1447632096 | Ltcarerx Consulting LLC | Pharmacy | 15430 Frances Ln Nw, Miltona, MN 56354-8320 | 2015-06-19 |
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184244527 | Kam Homecare | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1500 Nicollet Ave Apt 305, Minneapolis, MN 55403-2724 | 2020-04-24 |
| 1295291573 | Tricia Bastian | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 607 4th St S, Walker, MN 56484-6400 | 2019-02-12 |
| 1881163632 | Jacob Wrich | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 603 3rd St W Apt 1, Hastings, MN 55033-1127 | 2018-11-21 |
| 1003394479 | Malissa Ann Costanzo | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 844 8th Ave Se, Forest Lake, MN 55025 | 2018-07-30 |
| 1154814564 | Laurie K. Tazelaar-williams | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5253 W Bald Eagle Blvd, White Bear Lake, MN 55110-6532 | 2018-06-11 |
| 1205340577 | Dale Conrad Forslin | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1029 Highway 65 Ste 107, Braham, MN 55006-3360 | 2017-11-25 |
| 1952831026 | Noble Senior Center Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1094 University Ave W, Saint Paul, MN 55104 | 2017-06-12 |
| 1407396336 | Viko Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5651 69th Ave N, 203, Brooklyn Park, MN 55429-1579 | 2017-02-25 |
| 1972052702 | Marie-noel Hiol-hiol | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 14642 Quartz Ter Nw, Ramsey, MN 55303-4581 | 2016-09-21 |
| 1750839569 | Kubra Residential Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1711 W 143rd St Apt 120, Burnsville, MN 55306-7989 | 2016-09-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.