Active NPI
Kenneth Martin III, OTR/L
- Occupational Therapist
- Bremen, GA
National Provider Identifier
1700407673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 0119-008582
- Practice address
- 315 Field St
Bremen, GA 30110-2105 - Phone
- (770) 537-4482
- NPI assigned
- May 2, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | 0119-008582 | VA | Primary |
Addresses
Primary practice location
315 Field St
Bremen, GA 30110-2105
Mailing address
6009 Zurich Dr
Richmond, VA 23224-4527
Phone (804) 972-8010
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0119-008582 | VA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588377600000",
"number": "1700407673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6009 ZURICH DR",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232244527",
"telephone_number": "804-972-8010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 FIELD ST",
"city": "BREMEN",
"state": "GA",
"postal_code": "301102105",
"telephone_number": "770-537-4482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "KENNETH",
"name_suffix": "III",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-05-02",
"last_updated": "2020-05-02",
"certification_date": "2020-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "VA",
"license": "0119-008582",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bremen, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.