Provider Demographics
NPI:1508559915
Name:MARTINEZ, JANET ALISHA
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ALISHA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 N SAM HOUSTON PKWY W STE 240
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77086-1466
Mailing Address - Country:US
Mailing Address - Phone:832-968-7155
Mailing Address - Fax:713-383-9795
Practice Address - Street 1:4100 N SAM HOUSTON PKWY W STE 240
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77086-1466
Practice Address - Country:US
Practice Address - Phone:832-968-7155
Practice Address - Fax:713-383-9795
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX404184224Z00000X
TX217901224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant