Provider Demographics
NPI:1659923183
Name:MARTIN, KATHRYN DIAN (OTD, OTR)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DIAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:DIAN
Other - Last Name:MEHRLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR
Mailing Address - Street 1:9919 TOWNE RD
Mailing Address - Street 2:4695 E. NORTHFIELD DRIVE
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4695 E NORTHFIELD DR
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1784
Practice Address - Country:US
Practice Address - Phone:317-520-4748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006907A225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist