Individual
COLLEEN MARTONICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSOTR/L, CLT
Contact information
Practice address
405 N WICKHAM RD STE 103, MELBOURNE, FL 32935
(321) 327-8509
(321) 327-2130
Mailing address
405 N WICKHAM RD, MELBOURNE, FL 32935-8628
(321) 327-8509
(321) 327-2130
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OC-008065
PA
225X00000X
Occupational Therapist
Primary
OT18735
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447433
BLUE SHIELD
—
01
—
388447
HEALTH AMERICA ASSURANCE
—
01
—
393533
HEALTH AMERICA ASSURANCE
—
01
—
393534
HEALTH AMERICA ASSURANCE
—
01
—
814187
FIRST PRIORITY
—
01
—
814251
FIRST PRIORITY
—
01
—
818055
FIRST PRIORITY
—
01
—
OT18735
DOH
FL
Enumeration date
12/13/2006
Last updated
08/24/2018
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