Provider Demographics
NPI:1689132599
Name:MOTARI, MARTHA K
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:K
Last Name:MOTARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 W PIONEER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-7627
Mailing Address - Country:US
Mailing Address - Phone:214-952-7536
Mailing Address - Fax:
Practice Address - Street 1:1108 W PIONEER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-7627
Practice Address - Country:US
Practice Address - Phone:214-952-7536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-10
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139966363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health