Provider Demographics
NPI:1922217702
Name:OSBORNE, MARTHA JO (COTA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JO
Last Name:OSBORNE
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 1:303 N MADISON AVE
Mailing Address - Street 2:APT., 3
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-3691
Mailing Address - Country:US
Mailing Address - Phone:731-695-0885
Mailing Address - Fax:
Practice Address - Street 1:303 N. MADISON AVE
Practice Address - Street 2:APT 3
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142
Practice Address - Country:US
Practice Address - Phone:731-695-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001249A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant