Provider Demographics
NPI:1679115026
Name:MARTINEZ, PAUL IVAN (OTR, MOT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:IVAN
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:OTR, MOT
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:IVAN
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR, MOT
Mailing Address - Street 1:5707 TPC PKWY APT 921
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2788
Mailing Address - Country:US
Mailing Address - Phone:915-253-2591
Mailing Address - Fax:
Practice Address - Street 1:7400 MERTON MINTER ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:210-617-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117107225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist