Provider Demographics
NPI:1962741835
Name:MARTIN, JULISSA BARRERA (OT, MOT)
Entity type:Individual
Prefix:
First Name:JULISSA
Middle Name:BARRERA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OT, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 S CREEKMIST PL
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3744
Mailing Address - Country:US
Mailing Address - Phone:713-364-4239
Mailing Address - Fax:
Practice Address - Street 1:1217 W HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5012
Practice Address - Country:US
Practice Address - Phone:713-364-4239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2022-07-21
Deactivation Date:2019-01-23
Deactivation Code:
Reactivation Date:2020-05-06
Provider Licenses
StateLicense IDTaxonomies
TX115231225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist