Provider Demographics
NPI:1477115160
Name:MARTIN, DANIEL (OTR)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12139 WINDSOR SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3059
Mailing Address - Country:US
Mailing Address - Phone:765-418-6276
Mailing Address - Fax:
Practice Address - Street 1:900 N FORD RD
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1199
Practice Address - Country:US
Practice Address - Phone:317-873-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN410155225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics