Active NPI
Courtney Fitzgerald Martin, MS, OTR
- Occupational Therapist
- Green Bay, WI
National Provider Identifier
1134430721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4794-026
- Practice address
- 1760 Shawano Ave
Green Bay, WI 54303-3216 - Phone
- (920) 499-5191
- NPI assigned
- Jun 29, 2010
- Last updated
- Jun 29, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 4794-026 | WI | Primary |
Addresses
Primary practice location
1760 Shawano Ave
Green Bay, WI 54303-3216
Mailing address
1760 Shawano Ave
Green Bay, WI 54303-3216
Phone (920) 499-5191
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4794-026 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277769600000",
"number": "1134430721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1760 SHAWANO AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543033216",
"telephone_number": "920-499-5191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1760 SHAWANO AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543033216",
"telephone_number": "920-499-5191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FITZGERALD MARTIN",
"first_name": "COURTNEY",
"credential": "MS, OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-29",
"last_updated": "2010-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "4794-026",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.