Basic Information
| Provider Information | |||||||||
| NPI: | 1093295750 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | ELIZBETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 E LINGLEVILLE RD APT 517 | ||||||||
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| City: | STEPHENVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764012128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702794330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 809 E NAVARRO AVE | ||||||||
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| City: | DE LEON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764441275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2548932075 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2018 | ||||||||
| LastUpdateDate: | 08/21/2018 | ||||||||
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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 | 224Z00000X | 215067 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.