Provider Demographics
NPI:1841567617
Name:MARTIN, VIVIAN ANDREA (OTD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:ANDREA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26114 RIPLEY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-3624
Mailing Address - Country:US
Mailing Address - Phone:832-526-9399
Mailing Address - Fax:
Practice Address - Street 1:26114 RIPLEY HILLS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-3624
Practice Address - Country:US
Practice Address - Phone:832-526-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114383225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics