Individual
MISS CHRISTINA RENAE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2940 N CLINTON ST, FORT WAYNE, IN 46805-1910
(260) 484-4304
Mailing address
2940 N CLINTON ST, FORT WAYNE, IN 46805-1910
(260) 484-4304
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001523A
IN
Other
Enumeration date
05/24/2010
Last updated
05/24/2010
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