Provider Demographics
NPI:1295958684
Name:MARTINEZ, KAREN ALICIA
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ALICIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ALICIA
Other - Last Name:MESTAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 ADKINS CT
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-2908
Mailing Address - Country:US
Mailing Address - Phone:505-693-3655
Mailing Address - Fax:
Practice Address - Street 1:956 VALLEY VIEW CIR
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4464
Practice Address - Country:US
Practice Address - Phone:800-867-7116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1013224Z00000X
WA1157224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant