Provider Demographics
NPI:1508384314
Name:MARTIN, TONYA LYNN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 REDBUD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-5833
Mailing Address - Country:US
Mailing Address - Phone:937-789-8022
Mailing Address - Fax:
Practice Address - Street 1:2150 MONTEGO DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-6464
Practice Address - Country:US
Practice Address - Phone:937-390-9913
Practice Address - Fax:937-390-9915
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.04283224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant