Basic Information
| Provider Information | |||||||||
| NPI: | 1942531298 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MARTINA | ||||||||
| FirstName: | JAIME | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 E 79TH ST | ||||||||
| Address2: | APT 17K | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100750951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015753663 | ||||||||
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| Practice Location | |||||||||
| Address1: | 917 BEVILLE RD | ||||||||
| Address2: | SUITE G | ||||||||
| City: | SOUTH DAYTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321191712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867564395 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2010 | ||||||||
| LastUpdateDate: | 07/28/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 015463-1 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 46TR00409000 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.