Provider Demographics
NPI:1194024919
Name:MARTINEZ, ANISLEY (OT)
Entity Type:Individual
Prefix:
First Name:ANISLEY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 NW 87TH AVE
Mailing Address - Street 2:APT G 220
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4584
Mailing Address - Country:US
Mailing Address - Phone:305-308-0889
Mailing Address - Fax:
Practice Address - Street 1:140 NW 87TH AVE
Practice Address - Street 2:APT G 220
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4584
Practice Address - Country:US
Practice Address - Phone:308-308-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
18988225XP0200X
FL18988225X00000X
FL11196224ZL0004X, 224ZR0403X, 224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No224ZL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantLow Vision
No224ZR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantDriving and Community Mobility
No224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100978100Medicaid