Provider Demographics
NPI:1548357031
Name:STITES, MARTIN JAMES (OT, DC)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:JAMES
Last Name:STITES
Suffix:
Gender:M
Credentials:OT, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14622 VENTURA BLVD
Mailing Address - Street 2:SUITE #205
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-285-4242
Mailing Address - Fax:818-285-4244
Practice Address - Street 1:14622 VENTURA BLVD
Practice Address - Street 2:SUITE #205
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-285-4242
Practice Address - Fax:818-285-4244
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGT4597225X00000X
CADC29007111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
W17077Medicare UPIN