Provider Demographics
NPI:1619416252
Name:MARTINEZ, SARAH (COTA/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MARTINEZ
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 1:15604 GREENLEAF BAY ST
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-0210
Mailing Address - Country:US
Mailing Address - Phone:135-700-1568
Mailing Address - Fax:
Practice Address - Street 1:2370 BRUCE B DOWNS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-9215
Practice Address - Country:US
Practice Address - Phone:813-973-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA18879224Z00000X
FL106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst