Provider Demographics
NPI:1679051874
Name:MARTINEZ, LAURA ISABEL (COTA)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ISABEL
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-4969
Mailing Address - Country:US
Mailing Address - Phone:956-463-3909
Mailing Address - Fax:
Practice Address - Street 1:1208 S BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-7906
Practice Address - Country:US
Practice Address - Phone:956-969-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210226224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant