Provider Demographics
NPI:1427073964
Name:MARTINEZ, CHRISTINE M (OTR/L)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 CHERRYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7360
Mailing Address - Country:US
Mailing Address - Phone:760-518-5924
Mailing Address - Fax:
Practice Address - Street 1:1925 CHERRYWOOD ST
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7360
Practice Address - Country:US
Practice Address - Phone:760-518-5924
Practice Address - Fax:760-518-5924
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5350225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACT0053500Medicaid
CAOT0005350OtherBLUE SHIELD
CA330924107Medicare UPIN
CACT0053500Medicaid