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General NPI Number Information
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NPI Number | 1205458668
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Entity Type | Individual
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Provider Name | MIKAH VICTORIA MARTINEZ OTA
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Gender | Female
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Dates
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Enumeration Date | 05/08/2020
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Last Update Date | 05/08/2020
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Provider Practice Location Address
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Address Line | 6738 SHARPCREST ST
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City | HOUSTON
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State | TX
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Zip | 77074-6214
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Country | US
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Telephone | 979-318-9626
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Fax |
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Provider Business Mailing Address
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Address Line | 323 BIRCH ST
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City | WALLIS
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State | TX
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Zip | 77485-9395
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Country | US
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Telephone |
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Fax |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 216177
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License Number State | TX
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