Individual
NICOLE M MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3361 S 54TH ST, MILWAUKEE, WI 53219-4424
(414) 588-0797
Mailing address
3361 S 54TH ST, MILWAUKEE, WI 53219-4424
(414) 588-0797
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1982-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41039500
—
WI
Enumeration date
05/03/2007
Last updated
07/08/2007
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