Provider Demographics
NPI:1932348422
Name:MARTHA FLORES, PHD, OT, LLC
Entity Type:Organization
Organization Name:MARTHA FLORES, PHD, OT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, OTR
Authorized Official - Phone:520-419-6116
Mailing Address - Street 1:PO BOX 57083
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85732-7083
Mailing Address - Country:US
Mailing Address - Phone:520-419-6616
Mailing Address - Fax:
Practice Address - Street 1:5649 E 7TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3260
Practice Address - Country:US
Practice Address - Phone:520-419-6616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty