Provider Demographics
NPI:1821339243
Name:WHEATLEY, MARTHA
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:WHEATLEY
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 1:10016 GOLDEN POND DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-8608
Mailing Address - Country:US
Mailing Address - Phone:859-391-8095
Mailing Address - Fax:
Practice Address - Street 1:10016 GOLDEN POND DR
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-8608
Practice Address - Country:US
Practice Address - Phone:859-391-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator