Basic Information
| Provider Information | |||||||||
| NPI: | 1033388921 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINO | ||||||||
| FirstName: | ROSE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1145 S. UTICA AVENUE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185793826 | ||||||||
| FaxNumber: | 9185791262 | ||||||||
| Practice Location | |||||||||
| Address1: | 1145 S UTICA AVE | ||||||||
| Address2: | SUITE 262 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185793035 | ||||||||
| FaxNumber: | 9185793299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2008 | ||||||||
| LastUpdateDate: | 05/27/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT1161 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 100652190D | 05 | OK | MEDICAID |