Provider Demographics
NPI:1639372584
Name:MARTIN, CATHERINE SHIRLEY (OTR)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SHIRLEY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 HOLLY VILLA CIR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-3726
Mailing Address - Country:US
Mailing Address - Phone:201-486-0340
Mailing Address - Fax:
Practice Address - Street 1:733 PLANTATION ESTATES DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-9116
Practice Address - Country:US
Practice Address - Phone:704-845-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6424225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist