Provider Demographics
NPI:1326655713
Name:PORTER, JAMARTA MERCEDES
Entity Type:Individual
Prefix:
First Name:JAMARTA
Middle Name:MERCEDES
Last Name:PORTER
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 1:6248 FOREST CREST CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-8733
Mailing Address - Country:US
Mailing Address - Phone:513-568-4193
Mailing Address - Fax:
Practice Address - Street 1:6248 FOREST CREST CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-8733
Practice Address - Country:US
Practice Address - Phone:513-568-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.020926225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist