Provider Demographics
NPI:1285768580
Name:WRIGHT, MARTHA MARTIN (MHS, ORTL)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:MARTIN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MHS, ORTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6606 ABERCORN ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5817
Mailing Address - Country:US
Mailing Address - Phone:912-351-4263
Mailing Address - Fax:912-351-9650
Practice Address - Street 1:6606 ABERCORN ST
Practice Address - Street 2:SUITE 118
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5817
Practice Address - Country:US
Practice Address - Phone:912-351-4263
Practice Address - Fax:912-351-9650
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000663225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00848405AMedicaid
67BBBBFMedicare ID - Type Unspecified