Provider Demographics
NPI:1063775815
Name:HARTGRAVES, MARTHA (OT)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:HARTGRAVES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-6214
Mailing Address - Country:US
Mailing Address - Phone:801-380-8202
Mailing Address - Fax:
Practice Address - Street 1:2009 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3418
Practice Address - Country:US
Practice Address - Phone:915-533-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106899174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist