Provider Demographics
NPI:1093537938
Name:MARTINEZ, JESICA MAYELI (COTA/L)
Entity type:Individual
Prefix:
First Name:JESICA
Middle Name:MAYELI
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S RIVER DR APT 201
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-4638
Mailing Address - Country:US
Mailing Address - Phone:480-734-4134
Mailing Address - Fax:
Practice Address - Street 1:825 S RIVER DR APT 201
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-4638
Practice Address - Country:US
Practice Address - Phone:480-734-4134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-047238225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist