Provider Demographics
NPI:1619528668
Name:MARTIN, BETH ANN (OTA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WILLOW RUN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-2717
Mailing Address - Country:US
Mailing Address - Phone:865-755-2574
Mailing Address - Fax:
Practice Address - Street 1:3382 ANDERSONVILLE HWY
Practice Address - Street 2:
Practice Address - City:ANDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37705-3816
Practice Address - Country:US
Practice Address - Phone:865-494-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1147224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant