Provider Demographics
NPI:1679955116
Name:MARTIN, SYMONTEE
Entity Type:Individual
Prefix:
First Name:SYMONTEE
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 1:324 BARDON ST
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-3604
Mailing Address - Country:US
Mailing Address - Phone:330-641-9817
Mailing Address - Fax:
Practice Address - Street 1:324 BARDON ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-3604
Practice Address - Country:US
Practice Address - Phone:330-641-9817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-21
Last Update Date:2015-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401085710510376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide