Provider Demographics
NPI:1306982566
Name:MARTINEZ, LUIS (OT)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 WEST MILE 3 ROAD
Mailing Address - Street 2:SUITE A-103
Mailing Address - City:PALMHURST
Mailing Address - State:TX
Mailing Address - Zip Code:78573
Mailing Address - Country:US
Mailing Address - Phone:956-585-9889
Mailing Address - Fax:956-585-9896
Practice Address - Street 1:123 WEST MILE 3 ROAD
Practice Address - Street 2:SUITE A-103
Practice Address - City:PALMHURST
Practice Address - State:TX
Practice Address - Zip Code:78573
Practice Address - Country:US
Practice Address - Phone:956-585-9889
Practice Address - Fax:956-585-9896
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110662225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110662OtherLICENSE