Individual
MRS. SANDRA DENISE MARTIN
Active
Individual
MRS. SANDRA DENISE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6010
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1412M
BCBS PROVIDER #
NC
01
—
187647
MEDCOST PROVIDER #
NC
01
—
808087
BLUE MEDICARE PROVIDER #
NC
Enumeration date
05/31/2006
Last updated
04/10/2008
Update your record
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