Provider Demographics
NPI:1235298282
Name:MARTIN, TINA GARRARD (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:GARRARD
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 TALLOW FOREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539
Mailing Address - Country:US
Mailing Address - Phone:281-337-0973
Mailing Address - Fax:281-337-0973
Practice Address - Street 1:101 BAY COLONY ELEMENTARY DR
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3950
Practice Address - Country:US
Practice Address - Phone:281-534-8100
Practice Address - Fax:281-534-8125
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104655225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics