Provider Demographics
NPI:1578942462
Name:MARTELL, MONIQUE THERESE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:THERESE
Last Name:MARTELL
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:THERESE
Other - Last Name:DESANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:32080 NW MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINS
Mailing Address - State:OR
Mailing Address - Zip Code:97133-2012
Mailing Address - Country:US
Mailing Address - Phone:617-957-4902
Mailing Address - Fax:
Practice Address - Street 1:32080 NW MEADOW DR
Practice Address - Street 2:
Practice Address - City:NORTH PLAINS
Practice Address - State:OR
Practice Address - Zip Code:97133-2012
Practice Address - Country:US
Practice Address - Phone:617-957-4902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-25
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60555389225X00000X
VA0119006034225X00000X
OR310375225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist