MEDICARE: RENEA MARTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372500000X	Chore Provider

General Provider Information

NPI Number	:	1235813544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEA MARTIN

Provider Business Mailing Address
First Line	:	4676 COUNTRY LN
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-6113
Country	:	US
Telephone Number	:	216-389-4299
Fax Number	:

Provider Business Practice Location Address
First Line	:	4676 COUNTRY LN
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-6113
Country	:	US
Telephone Number	:	216-389-4299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	06/15/2023

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Directions to “ RENEA MARTIN ” Practice Location

Language	Start Address	Practice Location

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