Provider Demographics
NPI:1801168422
Name:MARTIN, PAIGE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12840 HILLCREST RD
Mailing Address - Street 2:SUITE E104
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1528
Mailing Address - Country:US
Mailing Address - Phone:972-404-3077
Mailing Address - Fax:
Practice Address - Street 1:12840 HILLCREST RD
Practice Address - Street 2:SUITE E104
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1528
Practice Address - Country:US
Practice Address - Phone:972-404-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116109225XP0200X
CA11455225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics