Provider Demographics
NPI:1275701401
Name:AURELIO, MARTIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:AURELIO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W AMERICAN CANYON RD STE 580-279
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1162
Mailing Address - Country:US
Mailing Address - Phone:707-853-0315
Mailing Address - Fax:
Practice Address - Street 1:101 W AMERICAN CANYON RD STE 580-279
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1162
Practice Address - Country:US
Practice Address - Phone:707-853-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT- 2047171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2047OtherOT LICENSE
977501OtherNBCOT
CA2047OtherCALIFORNIA OT LICENSE