Basic Information
| Provider Information | |||||||||
| NPI: | 1700277654 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERGUSON | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8968 DORRINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | ARLETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913316122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184895229 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7660 WYNGATE ST | ||||||||
| Address2: | |||||||||
| City: | TUJUNGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910421736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183521454 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2015 | ||||||||
| LastUpdateDate: | 02/13/2015 | ||||||||
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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 | OTA 639 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | OTA 639 | 01 | CA | STATE LICENSURE | OTHER | 1054840 | 01 | NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY | OTHER |