Provider Demographics
NPI:1255678090
Name:MARTIN, DEBRA MARIE (OTA/L)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STEFANIAK AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-2061
Mailing Address - Country:US
Mailing Address - Phone:508-525-5682
Mailing Address - Fax:
Practice Address - Street 1:18 HAMMOND ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-1513
Practice Address - Country:US
Practice Address - Phone:508-799-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2113224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant