Provider Demographics
NPI:1881620318
Name:MARTINEZ, ANGELA D (MS OTRL)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:D
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:114 S HI LUSI
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:847-636-2705
Mailing Address - Fax:
Practice Address - Street 1:114 S HI LUSI
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056
Practice Address - Country:US
Practice Address - Phone:847-636-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002502A225X00000X
MI5201004328225X00000X
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAM20910905POtherEARLY INTERVENTION
IL01635968OtherBLUE CROSS BLUE SHIELD