Mark David Martin, COTA/L

Key facts

NPI

1083588933

Entity type

Individual (NPI type 1)

Primary specialty

Occupational Therapy Assistant 224Z00000X

License

057.006158 (IL)

Practice address

410 N 2ND St
Marshall, IL 62441-1010

Phone

(217) 826-2358

NPI assigned

Oct 2, 2025

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

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 2, 2025.

{
    "created_epoch": "1759363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759363200000",
    "number": "1083588933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 W MADISON ST APT 4",
            "city": "PARIS",
            "state": "IL",
            "postal_code": "619442174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 N 2ND ST",
            "city": "MARSHALL",
            "state": "IL",
            "postal_code": "624411010",
            "telephone_number": "217-826-2358"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 S Eads Ave",
            "address_purpose": "LOCATION",
            "city": "Paris",
            "state": "IL",
            "postal_code": "619441938",
            "country_code": "US",
            "telephone_number": "217-465-5395",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-10-02",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": "IL",
            "license": "057.006158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Marshall, IL · Occupational Therapy Assistant in Illinois