Individual
PAMELA C MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
200 CENTER STREET, MORIARTY, NM 87035-2000
(505) 832-4471
(505) 832-4472
Mailing address
PO BOX 2000, MORIARTY, NM 87035-2000
(505) 832-4471
(505) 832-4472
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3115
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139
—
TX
Enumeration date
08/13/2013
Last updated
08/13/2013
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