Provider Demographics
NPI:1801594940
Name:MARTY, JILL MARIE
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:MARTY
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 1:8646 N HONEYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44677-9742
Mailing Address - Country:US
Mailing Address - Phone:330-988-0915
Mailing Address - Fax:
Practice Address - Street 1:8646 N HONEYTOWN RD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:OH
Practice Address - Zip Code:44677-9742
Practice Address - Country:US
Practice Address - Phone:330-988-0915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide