Provider Demographics
NPI:1093295750
Name:MARTINEZ, ELIZBETH
Entity Type:Individual
Prefix:
First Name:ELIZBETH
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E LINGLEVILLE RD APT 517
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-2128
Mailing Address - Country:US
Mailing Address - Phone:870-279-4330
Mailing Address - Fax:
Practice Address - Street 1:809 E NAVARRO AVE
Practice Address - Street 2:
Practice Address - City:DE LEON
Practice Address - State:TX
Practice Address - Zip Code:76444-1275
Practice Address - Country:US
Practice Address - Phone:254-893-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215067224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant