Provider Demographics
NPI:1285496455
Name:MARTIN, MARIE
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 CHAMPIONSHIP CT UNIT 6
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8308
Mailing Address - Country:US
Mailing Address - Phone:330-423-9450
Mailing Address - Fax:
Practice Address - Street 1:4650 CHAMPIONSHIP CT UNIT 6
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8308
Practice Address - Country:US
Practice Address - Phone:330-423-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide