Healthcare Provider Details

I. General information

NPI: 1063246411
Provider Name (Legal Business Name): ROLAND RYAN MARTINEZ JR. OTR, OTD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14207 HIGGINS RD
SAN ANTONIO TX
78217-1252
US

IV. Provider business mailing address

14207 HIGGINS RD
SAN ANTONIO TX
78217-1252
US

V. Phone/Fax

Practice location:
  • Phone: 210-826-4492
  • Fax: 210-826-7887
Mailing address:
  • Phone: 210-826-4492
  • Fax: 210-826-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number124872
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: