Provider Demographics
NPI:1447416565
Name:MARTIN, TERESA RENA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:RENA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1250 N INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3353
Mailing Address - Country:US
Mailing Address - Phone:405-573-0121
Mailing Address - Fax:405-572-0124
Practice Address - Street 1:1250 N INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-3353
Practice Address - Country:US
Practice Address - Phone:405-573-0121
Practice Address - Fax:405-572-0124
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK303225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist