Provider Demographics
NPI:1639476062
Name:MARTIN, CODI KAY (OTR/L)
Entity Type:Individual
Prefix:
First Name:CODI
Middle Name:KAY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CODI
Other - Middle Name:KAY
Other - Last Name:KESSLERCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:
Practice Address - Street 1:1210 GEMINI PL STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-6110
Practice Address - Country:US
Practice Address - Phone:614-262-0907
Practice Address - Fax:614-262-5269
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6649225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114106OtherOT LICENSE