Provider Demographics
NPI:1750188421
Name:MARTIN, LORETTA LYNNE (APS002972)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:LYNNE
Last Name:MARTIN
Suffix:
Gender:
Credentials:APS002972
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APS002972
Mailing Address - Street 1:241 PADDOCK CT STE 3
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1370
Mailing Address - Country:US
Mailing Address - Phone:740-363-1619
Mailing Address - Fax:
Practice Address - Street 1:241 PADDOCK CT STE 3
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1370
Practice Address - Country:US
Practice Address - Phone:740-363-1619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.0002972175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist