Provider Demographics
NPI:1902885064
Name:CARLSON, MARTHA J (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:CARLSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 NW 36TH WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4854
Mailing Address - Country:US
Mailing Address - Phone:352-359-0043
Mailing Address - Fax:352-371-0355
Practice Address - Street 1:1605 NW 36TH WAY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4854
Practice Address - Country:US
Practice Address - Phone:352-359-0043
Practice Address - Fax:352-371-0355
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL OT 0628225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U5782Medicare UPIN