Provider Demographics
NPI:1316069842
Name:DIAZ, MARTHA M (OTR)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:M
Last Name:DIAZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:M
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 NARNIA DR S
Mailing Address - Street 2:
Mailing Address - City:GRASONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21638-1300
Mailing Address - Country:US
Mailing Address - Phone:443-848-1079
Mailing Address - Fax:
Practice Address - Street 1:303 NARNIA DR S
Practice Address - Street 2:
Practice Address - City:GRASONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21638-1300
Practice Address - Country:US
Practice Address - Phone:443-848-1079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05681225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist