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General NPI Number Information
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NPI Number | 1437248663
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Entity Type | Individual
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Provider Name | AQUESHA MARTIN MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1799 MISSION PARK CT
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City | LOGANVILLE
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State | GA
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Zip | 30052-7511
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Country | US
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Telephone | 678-794-2445
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Fax | 770-979-2591
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Provider Business Mailing Address
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Address Line | 1799 MISSION PARK CT
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City | LOGANVILLE
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State | GA
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Zip | 30052-7511
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Country | US
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Telephone | 678-794-2445
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Fax | 770-979-2591
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT003614
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License Number State | GA
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