Provider Demographics
NPI:1780758110
Name:MARTIN, HEIDI LOBEL (MS OTRL)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:LOBEL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6420 COLEWOOD CT NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2921
Mailing Address - Country:US
Mailing Address - Phone:770-654-9542
Mailing Address - Fax:
Practice Address - Street 1:6420 COLEWOOD CT NW
Practice Address - Street 2:STE 426
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-2921
Practice Address - Country:US
Practice Address - Phone:770-654-9542
Practice Address - Fax:404-255-9239
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-18
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003007225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA393126OtherBCBS PIN
GA000916363BMedicaid