Provider Demographics
NPI:1205684537
Name:MARTIN, AMY KAYE
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KAYE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 WADE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSHIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77423-9230
Mailing Address - Country:US
Mailing Address - Phone:281-782-5434
Mailing Address - Fax:
Practice Address - Street 1:1259 FM 1463 RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5471
Practice Address - Country:US
Practice Address - Phone:832-437-6705
Practice Address - Fax:832-802-8082
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105311225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist