Provider Demographics
NPI:1700277654
Name:FERGUSON, MARTHA (OTA/L)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8968 DORRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6122
Mailing Address - Country:US
Mailing Address - Phone:818-489-5229
Mailing Address - Fax:
Practice Address - Street 1:7660 WYNGATE ST
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-1736
Practice Address - Country:US
Practice Address - Phone:818-352-1454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 639224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOTA 639OtherSTATE LICENSURE
1054840OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY