Healthcare Provider Details

I. General information

NPI: 1295859221
Provider Name (Legal Business Name): SHARI LYNN MARTIN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90590 COUNTY ROAD 215
DECATUR MI
49045-9261
US

IV. Provider business mailing address

90590 COUNTY ROAD 215
DECATUR MI
49045-9261
US

V. Phone/Fax

Practice location:
  • Phone: 269-913-2178
  • Fax:
Mailing address:
  • Phone: 269-913-2178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056-006226
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31004352A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201007064
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: