Healthcare Provider Details

I. General information

NPI: 1982989299
Provider Name (Legal Business Name): MARINA CHANG MARTINEZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARINA SONGLUE CHANG OTR/L

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 GRAPEVINE MILLS PKWY APT 1916
GRAPEVINE TX
76051-1973
US

IV. Provider business mailing address

27676 PIERCE ST
SOUTHFIELD MI
48076-3568
US

V. Phone/Fax

Practice location:
  • Phone: 586-883-0319
  • Fax:
Mailing address:
  • Phone: 586-883-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number114418
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5201007009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: