Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP010009 | PA |
NPI | 1023681327 |
---|---|
Provider Name | Olivia Pearl Martin |
First Address | Mechanicsburg, PA 17055-6625 |
Second Address | Carlisle, PA 17015-7623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2021 |
Last Update Date | 23/07/2021 |