Provider Demographics
NPI:1851981765
Name:MARTIN, AMY LOUISE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
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 1:529 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1913
Mailing Address - Country:US
Mailing Address - Phone:740-706-1003
Mailing Address - Fax:
Practice Address - Street 1:1307 WILLIAMSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:WV
Practice Address - Zip Code:26187-8168
Practice Address - Country:US
Practice Address - Phone:304-588-7959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist