Provider Demographics
NPI:1750722955
Name:MARTIN, SANDRA W (MSOTR/L)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:W
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ATWATER AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-8200
Mailing Address - Country:US
Mailing Address - Phone:251-680-3759
Mailing Address - Fax:866-345-4906
Practice Address - Street 1:201 ATWATER AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-8200
Practice Address - Country:US
Practice Address - Phone:251-680-3759
Practice Address - Fax:866-345-4906
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3562225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics