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General NPI Number Information
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NPI Number | 1740458439
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Entity Type | Individual
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Provider Name | KELLY E MARTINEZ COTA/C.
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Gender | Female
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 6960 DESTINY DR STE 117
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City | ROCKLIN
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State | CA
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Zip | 95677-2995
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Country | US
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Telephone | 916-243-8570
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Fax |
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Provider Business Mailing Address
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Address Line | 2021 TRIMBLE WAY
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City | SACRAMENTO
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State | CA
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Zip | 95825-2118
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Country | US
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Telephone | 916-243-8570
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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 | OTA370
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License Number State | CA
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