Healthcare Provider Details

I. General information

NPI: 1710096490
Provider Name (Legal Business Name): IRENE MARTINEZ OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 CORAL WAY SUITE 203
MIAMI FL
33155
US

IV. Provider business mailing address

2364 SW 26 ST
MIAMI FL
33133
US

V. Phone/Fax

Practice location:
  • Phone: 305-859-9503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 002577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: