Provider Demographics
NPI:1114517786
Name:JACOB, MARTHA BELLE
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:BELLE
Last Name:JACOB
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 1:411 S. 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:NEW VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:45159
Mailing Address - Country:US
Mailing Address - Phone:937-218-3335
Mailing Address - Fax:
Practice Address - Street 1:411 S. 2ND STREET
Practice Address - Street 2:
Practice Address - City:NEW VIENNA
Practice Address - State:OH
Practice Address - Zip Code:45159
Practice Address - Country:US
Practice Address - Phone:937-218-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health