Provider Demographics
NPI:1033430137
Name:MARTINEZ, JESSICA PATRICIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:PATRICIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:PATRICIA
Other - Last Name:WAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5447 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-4009
Mailing Address - Country:US
Mailing Address - Phone:313-832-1100
Mailing Address - Fax:
Practice Address - Street 1:2075 E WEST MAPLE RD
Practice Address - Street 2:SUITE B-204
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-3816
Practice Address - Country:US
Practice Address - Phone:248-926-0909
Practice Address - Fax:248-624-3332
Is Sole Proprietor?:No
Enumeration Date:2010-06-13
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007703174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist