Provider Demographics
NPI:1336168178
Name:MARTIN, STACIA J (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:STACIA
Middle Name:J
Last Name:MARTIN
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 1:327 CHASE HILL RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03216-4109
Mailing Address - Country:US
Mailing Address - Phone:603-496-5214
Mailing Address - Fax:
Practice Address - Street 1:327 CHASE HILL RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NH
Practice Address - Zip Code:03216-4109
Practice Address - Country:US
Practice Address - Phone:603-496-5214
Practice Address - Fax:603-776-0381
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1336225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1065349OtherAETNA
NH386488OtherMVP
NH13Y008938NH01OtherANTHEM BC/BS
NH30413840Medicaid
NH30413840Medicaid