Jerry Martinez, COTA
Individual provider Active NPI Contractor · Alton, TX
NPI 1003269440 · NPPES record last updated Jul 21, 2016
Key facts
- NPI
- 1003269440
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 209135 (TX)
- Practice address
- 921 E Main Ave Ste 5
Alton, TX 78573-1606 - Phone
- (956) 519-2500
- NPI assigned
- Jul 21, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209135 | TX | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 209135 | TX | Yes |
Addresses
Primary practice location
921 E Main Ave Ste 5
Alton, TX 78573-1606
Mailing address
921 E Main Ave Ste 5
Alton, TX 78573-1606
Phone (956) 519-2500
Other providers in Alton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.