Provider Demographics
NPI:1033495247
Name:MARTIN, MARY J (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 ROCKSIDE RD
Mailing Address - Street 2:STE. 240
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2368
Mailing Address - Country:US
Mailing Address - Phone:216-901-0400
Mailing Address - Fax:
Practice Address - Street 1:6500 ROCKSIDE RD
Practice Address - Street 2:STE. 240
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2368
Practice Address - Country:US
Practice Address - Phone:216-901-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007162225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist