Provider Demographics
NPI:1750677910
Name:MARTIN, DEBRA DIANN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:DIANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105036 S 3570 RD
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-6454
Mailing Address - Country:US
Mailing Address - Phone:405-567-7386
Mailing Address - Fax:
Practice Address - Street 1:105036 S 3570 RD
Practice Address - Street 2:
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864-6454
Practice Address - Country:US
Practice Address - Phone:405-567-7386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1140224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant