Provider Demographics
NPI:1770166910
Name:MARTIN, LATASHA SPRING
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:SPRING
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 1:660 LITTLE STONY RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:WV
Mailing Address - Zip Code:26815-5060
Mailing Address - Country:US
Mailing Address - Phone:304-902-0097
Mailing Address - Fax:
Practice Address - Street 1:271 MOUNTAIN TOP DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WV
Practice Address - Zip Code:26807-6042
Practice Address - Country:US
Practice Address - Phone:304-358-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant