Provider Demographics
NPI:1770932113
Name:MARTINEZ, MARY-KATE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:MARY-KATE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:MARY-KATE
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:75-02 162ND ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366
Mailing Address - Country:US
Mailing Address - Phone:718-591-1500
Mailing Address - Fax:718-591-8751
Practice Address - Street 1:75-02 162ND ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366
Practice Address - Country:US
Practice Address - Phone:718-591-1500
Practice Address - Fax:718-591-8751
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0204151172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker