Provider Demographics
NPI:1841665130
Name:MARTIN, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
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 1:7356 GARNERS FERRY RD STE 213
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2146
Mailing Address - Country:US
Mailing Address - Phone:803-708-0716
Mailing Address - Fax:803-708-0717
Practice Address - Street 1:7356 GARNERS FERRY RD STE 213
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2146
Practice Address - Country:US
Practice Address - Phone:803-708-0716
Practice Address - Fax:803-708-0717
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide