Provider Demographics
NPI:1679793574
Name:MARTHA H PATERSON
Entity Type:Organization
Organization Name:MARTHA H PATERSON
Other - Org Name:ARTISTIC ADVANTAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR CHT
Authorized Official - Phone:818-995-8303
Mailing Address - Street 1:3727 W MAGNOLIA BLVD
Mailing Address - Street 2:SUITE 710
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2818
Mailing Address - Country:US
Mailing Address - Phone:818-995-8303
Mailing Address - Fax:818-558-1487
Practice Address - Street 1:2031 WEST ALAMEDA
Practice Address - Street 2:SUITE 300
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2960
Practice Address - Country:US
Practice Address - Phone:818-995-8303
Practice Address - Fax:818-558-1487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91-6242225XE1200X, 225XH1200X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomicsGroup - Multi-Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN5293Medicare ID - Type Unspecified