Provider Demographics
NPI:1972725802
Name:JENIKE, MARTHA JOANNE (AT,C)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:JOANNE
Last Name:JENIKE
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:MS
Other - First Name:JODY
Other - Middle Name:
Other - Last Name:JENIKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2056 STEGMAN AVE.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404
Mailing Address - Country:US
Mailing Address - Phone:513-200-3111
Mailing Address - Fax:513-745-1963
Practice Address - Street 1:7430 BRIDGE POINT PASS
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-1916
Practice Address - Country:US
Practice Address - Phone:513-295-1756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0000722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer