Provider Demographics
NPI:1437444833
Name:MARTIN, JENNIFER K
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:K
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 1:210 WINDOM LN
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8104
Mailing Address - Country:US
Mailing Address - Phone:859-312-9900
Mailing Address - Fax:859-881-0521
Practice Address - Street 1:210 WINDOM LN
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8104
Practice Address - Country:US
Practice Address - Phone:859-312-9900
Practice Address - Fax:859-881-0521
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist