Individual
ANGELA D MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS OTRL
Contact information
Practice address
114 S HI LUSI, MT PROSPECT, IL 60056
(847) 636-2705
Mailing address
114 S HI LUSI, MT PROSPECT, IL 60056
(847) 636-2705
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
31002502A
IN
225X00000X
Occupational Therapist
5201004328
MI
225X00000X
Occupational Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635968
BLUE CROSS BLUE SHIELD
IL
01
—
AM20910905P
EARLY INTERVENTION
IL
Enumeration date
06/25/2006
Last updated
07/08/2007
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