Provider Demographics
NPI:1104301969
Name:EMBREE, MARTA ALDAY
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:ALDAY
Last Name:EMBREE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 BLOSSOMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6174
Mailing Address - Country:US
Mailing Address - Phone:817-319-9641
Mailing Address - Fax:
Practice Address - Street 1:2326 BLOSSOMWOOD DR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6174
Practice Address - Country:US
Practice Address - Phone:817-319-9641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17751225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist