Healthcare Provider Details

I. General information

NPI: 1093938532
Provider Name (Legal Business Name): BARBARA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 GREENCOVE TER APT 148
ALTAMONTE SPRINGS FL
32714-4543
US

IV. Provider business mailing address

633 GREENCOVE TER APT 148
ALTAMONTE SPRINGS FL
32714-4543
US

V. Phone/Fax

Practice location:
  • Phone: 407-682-2768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT1433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: