Provider Demographics
NPI:1225510977
Name:MARTINEZ, GRACE ISABEL (OTR)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:ISABEL
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:GRACIE
Other - Middle Name:ISABEL
Other - Last Name:ROSALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1905 UPLAND DR APT 1
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2462
Mailing Address - Country:US
Mailing Address - Phone:956-292-6681
Mailing Address - Fax:
Practice Address - Street 1:4503 S SUGAR RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7049
Practice Address - Country:US
Practice Address - Phone:956-386-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116124225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist