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General NPI Number Information
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NPI Number | 1205186665
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Entity Type | Individual
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Provider Name | RANDY F MARTI MAED, MSOTR
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Gender | Male
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 15 MICROLAB RD SUITE 101
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City | LIVINGSTON
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State | NJ
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Zip | 07039-1623
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Country | US
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Telephone | 973-992-8181
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Fax | 973-992-9797
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Provider Business Mailing Address
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Address Line | 15 MICROLAB RD SUITE 101
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City | LIVINGSTON
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State | NJ
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Zip | 07039-1623
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Country | US
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Telephone | 973-992-8181
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Fax | 973-992-9797
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 46TR00344900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | OC012406
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License Number State | PA
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