Provider Demographics
NPI:1245387117
Name:ROTHSTEIN MARTINEZ, NATALIE (OT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:ROTHSTEIN MARTINEZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 5209
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5209
Mailing Address - Country:US
Mailing Address - Phone:865-982-3400
Mailing Address - Fax:865-238-2034
Practice Address - Street 1:2030 CHILHOWEE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5285
Practice Address - Country:US
Practice Address - Phone:865-982-3400
Practice Address - Fax:865-238-2034
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6348225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ055257Medicaid