Provider Demographics
NPI:1144474693
Name:MARTIN, PETER PATRICK (OTR)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:PATRICK
Last Name:MARTIN
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8406
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-0406
Mailing Address - Country:US
Mailing Address - Phone:518-331-8898
Mailing Address - Fax:518-283-6799
Practice Address - Street 1:24 OAK STREET
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144
Practice Address - Country:US
Practice Address - Phone:518-331-8898
Practice Address - Fax:518-283-6799
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics