Provider Demographics
NPI:1710687710
Name:MARTIN, DESIREE (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:OH
Mailing Address - Zip Code:43964-1459
Mailing Address - Country:US
Mailing Address - Phone:740-275-8673
Mailing Address - Fax:
Practice Address - Street 1:102 ALLEY E
Practice Address - Street 2:
Practice Address - City:STRATTON
Practice Address - State:OH
Practice Address - Zip Code:43961
Practice Address - Country:US
Practice Address - Phone:740-275-8673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health