Provider Demographics
NPI:1770625519
Name:MARTINEZ, STACIA DAY (COTA)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:DAY
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 ARCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-3006
Mailing Address - Country:US
Mailing Address - Phone:615-612-6064
Mailing Address - Fax:
Practice Address - Street 1:3918 DICKERSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-1328
Practice Address - Country:US
Practice Address - Phone:615-397-2360
Practice Address - Fax:866-234-7086
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1399224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant