Provider Demographics
NPI:1083892541
Name:MARTIN, ADAM C (OT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:HAND TO PLOW
Other - Middle Name:RESOURCES
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1834 CAWTHON ROAD
Mailing Address - Street 2:
Mailing Address - City:PIONEER
Mailing Address - State:LA
Mailing Address - Zip Code:71266
Mailing Address - Country:US
Mailing Address - Phone:318-417-4848
Mailing Address - Fax:
Practice Address - Street 1:461 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-3829
Practice Address - Country:US
Practice Address - Phone:318-417-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C793Medicare PIN