Provider Demographics
NPI:1497507859
Name:BRUNO MARTINEZ, DEYMAR (OTA)
Entity Type:Individual
Prefix:
First Name:DEYMAR
Middle Name:
Last Name:BRUNO MARTINEZ
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 AVE BARBOSA
Mailing Address - Street 2:
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962-4780
Mailing Address - Country:US
Mailing Address - Phone:939-336-3333
Mailing Address - Fax:
Practice Address - Street 1:115 AVE BARBOSA
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-4780
Practice Address - Country:US
Practice Address - Phone:939-336-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1223224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant