Provider Demographics
NPI:1669887634
Name:POAGUE, MARTHA JEAN (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:JEAN
Last Name:POAGUE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:MARTHA
Other - Middle Name:JEAN
Other - Last Name:CHEATLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:100 HIGH POINT DR
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-9704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HIGH POINT DR
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-9704
Practice Address - Country:US
Practice Address - Phone:814-975-1245
Practice Address - Fax:814-837-9205
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006439224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant