Provider Demographics
NPI:1952494130
Name:MARTIN-POLK, PAMELA MICHELLE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MICHELLE
Last Name:MARTIN-POLK
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:MICHELLE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:3154 W 77TH STREET
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043
Mailing Address - Country:US
Mailing Address - Phone:310-849-2003
Mailing Address - Fax:323-971-5996
Practice Address - Street 1:3154 W 77TH STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043
Practice Address - Country:US
Practice Address - Phone:310-849-2003
Practice Address - Fax:323-971-5996
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3510225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist