Provider Demographics
NPI:1538309521
Name:MARTIN, JENNIFER RENEE (RPTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RPTA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RENEE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPTA
Mailing Address - Street 1:7008 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3907
Mailing Address - Country:US
Mailing Address - Phone:918-523-2600
Mailing Address - Fax:918-744-9729
Practice Address - Street 1:7008 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3907
Practice Address - Country:US
Practice Address - Phone:918-523-2600
Practice Address - Fax:918-744-9729
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK714225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant