Provider Demographics
NPI:1922385418
Name:OATIS, MARTHA (DA, LICAC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:OATIS
Suffix:
Gender:F
Credentials:DA, LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SAINT JAMES PL APT 4R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-2366
Mailing Address - Country:US
Mailing Address - Phone:347-460-5443
Mailing Address - Fax:
Practice Address - Street 1:214 SULLIVAN ST STE 3B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1354
Practice Address - Country:US
Practice Address - Phone:347-460-5443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI171100000X
MA171100000X
NY004867171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist