Provider Demographics
NPI:1275319048
Name:MARTIN, HEATHER ALLENE (OTD, OTR)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ALLENE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 OAK TREE LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5648
Mailing Address - Country:US
Mailing Address - Phone:972-765-3056
Mailing Address - Fax:
Practice Address - Street 1:7217 TELECOM PKWY STE 200
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2205
Practice Address - Country:US
Practice Address - Phone:972-495-6986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123930225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist