MEDICARE: VICTORIA DENISS MARTIN OTD, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	14180	NC

General Provider Information

NPI Number	:	1457923187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA DENISS MARTIN OTD, OTR/L

Provider Business Mailing Address
First Line	:	135 CHATHAM ST
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-4335
Country	:	US
Telephone Number	:	919-774-1281
Fax Number	:	919-774-1282

Provider Business Practice Location Address
First Line	:	135 CHATHAM ST
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-4335
Country	:	US
Telephone Number	:	919-774-1281
Fax Number	:	919-774-1282

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	06/19/2022

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