Provider Demographics
NPI:1578015723
Name:KOON, MARTHA LYNN (COTA/L)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LYNN
Last Name:KOON
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 1:1305 BOILING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4139
Mailing Address - Country:US
Mailing Address - Phone:864-458-7566
Mailing Address - Fax:864-288-8043
Practice Address - Street 1:1305 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4139
Practice Address - Country:US
Practice Address - Phone:864-458-7566
Practice Address - Fax:864-288-8043
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2808224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant