Provider Demographics
NPI:1508917170
Name:GARVEY, MARTHA D (MOTR/L)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:D
Last Name:GARVEY
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16301 WILDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33982-8665
Mailing Address - Country:US
Mailing Address - Phone:786-566-7992
Mailing Address - Fax:
Practice Address - Street 1:16301 WILDWOOD CT
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33982-8665
Practice Address - Country:US
Practice Address - Phone:786-566-7992
Practice Address - Fax:786-566-7992
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12307225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891330700Medicaid