Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT 11418 | FL |
N | 225XM0800X | Mental Health | OT 11418 | FL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT 11418 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT 11418 | FL |
NPI | 1306869193 |
---|---|
Provider Name | Ms. Marianela Martinez |
First Address | Jacksonville, FL 32225-5279 |
Second Address | Jacksonville, FL 32225-5279 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 25/10/2019 |