MEDICARE: DR. VIVIAN ANDREA MARTIN OTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	114383	TX

General Provider Information

NPI Number	:	1841567617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIAN ANDREA MARTIN OTD

Provider Business Mailing Address
First Line	:	26114 RIPLEY HILLS DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-3624
Country	:	US
Telephone Number	:	832-526-9399
Fax Number	:

Provider Business Practice Location Address
First Line	:	26114 RIPLEY HILLS DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-3624
Country	:	US
Telephone Number	:	832-526-9399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	11/22/2011

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