Basic Information
| Provider Information | |||||||||
| NPI: | 1427575695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTA | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1958 DELAWARE ST | ||||||||
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| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482062646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863375361 | ||||||||
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| Practice Location | |||||||||
| Address1: | 542 16TH ST | ||||||||
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| City: | RAWLINS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 823015241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073242759 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2017 | ||||||||
| LastUpdateDate: | 08/28/2017 | ||||||||
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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 | 5201009878 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.