Provider Demographics
NPI:1740409598
Name:HOWARD, MARTHA (HOME CARE PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 NASHOBA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-1706
Mailing Address - Country:US
Mailing Address - Phone:614-278-7539
Mailing Address - Fax:
Practice Address - Street 1:564 NASHOBA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-1706
Practice Address - Country:US
Practice Address - Phone:614-278-7539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2509002171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH253349692901Medicaid