Provider Demographics
NPI:1053625137
Name:STEVENS, MARTHA (MOT,OTR/L)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MOT,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8439 BOBBY PL
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45005-4258
Mailing Address - Country:US
Mailing Address - Phone:513-465-4903
Mailing Address - Fax:937-550-4474
Practice Address - Street 1:8439 BOBBY PL
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45005-4258
Practice Address - Country:US
Practice Address - Phone:513-465-4903
Practice Address - Fax:937-550-4474
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006730225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist