Provider Demographics
NPI:1699090209
Name:MARTINEZ, ABRAHAM JOSEPH (OTD)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:JOSEPH
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:ABE
Other - Middle Name:JOSEPH
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTD
Mailing Address - Street 1:450 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3045
Mailing Address - Country:US
Mailing Address - Phone:515-323-6485
Mailing Address - Fax:515-323-6486
Practice Address - Street 1:450 LAUREL ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3045
Practice Address - Country:US
Practice Address - Phone:515-323-6485
Practice Address - Fax:515-323-6486
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002104225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19172042Medicare PIN
IA19172Medicare PIN
IAIB3481005Medicare PIN
IAIB3481Medicare PIN