Provider Demographics
NPI:1457923187
Name:MARTIN, VICTORIA DENISS (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:DENISS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 CHATHAM ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4335
Mailing Address - Country:US
Mailing Address - Phone:919-774-1281
Mailing Address - Fax:919-774-1282
Practice Address - Street 1:135 CHATHAM ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4335
Practice Address - Country:US
Practice Address - Phone:919-774-1281
Practice Address - Fax:919-774-1282
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2022-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14180225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist