Provider Demographics
NPI:1326297193
Name:MARTIN, JENNIFER BETH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BETH
Last Name:MARTIN
Suffix:
Gender:F
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 1:6525 N MERIDIAN AVE
Mailing Address - Street 2:311
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1420
Mailing Address - Country:US
Mailing Address - Phone:800-728-1115
Mailing Address - Fax:
Practice Address - Street 1:6525 N MERIDIAN AVE
Practice Address - Street 2:311
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1420
Practice Address - Country:US
Practice Address - Phone:800-728-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1424225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist