Provider Demographics
NPI:1942306584
Name:KIRKPATRICK, MARTHA KAY (OTR L)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:KAY
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8870 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2512
Mailing Address - Country:US
Mailing Address - Phone:318-798-6300
Mailing Address - Fax:318-798-6309
Practice Address - Street 1:8870 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2512
Practice Address - Country:US
Practice Address - Phone:318-798-6300
Practice Address - Fax:318-798-6309
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10472225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CN91OtherPROVIDER NUMBER