Provider Demographics
NPI:1225879174
Name:MARTIAL ARTS THERAPY
Entity type:Organization
Organization Name:MARTIAL ARTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ANNABELL
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:903-445-9470
Mailing Address - Street 1:3213 SEATON ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-0505
Mailing Address - Country:US
Mailing Address - Phone:903-871-5053
Mailing Address - Fax:
Practice Address - Street 1:3213 SEATON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-0505
Practice Address - Country:US
Practice Address - Phone:903-871-5053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty