Provider Demographics
NPI:1245892918
Name:MARTINEZ, JILLIAN (MOT OTR/L)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CANTO DEL PAJARO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-4842
Mailing Address - Country:US
Mailing Address - Phone:505-690-9798
Mailing Address - Fax:
Practice Address - Street 1:43 CANTO DEL PAJARO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-4842
Practice Address - Country:US
Practice Address - Phone:505-690-9798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4078225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist