MEDICARE: JAMARTA MERCEDES PORTER

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	225700000X	Massage Therapist	33.020926	OH

General Provider Information

NPI Number	:	1326655713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMARTA MERCEDES PORTER

Provider Business Mailing Address
First Line	:	6248 FOREST CREST CT
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-8733
Country	:	US
Telephone Number	:	513-568-4193
Fax Number	:

Provider Business Practice Location Address
First Line	:	6248 FOREST CREST CT
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-8733
Country	:	US
Telephone Number	:	513-568-4193
Fax Number	:

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

Provider Enumeration Date	:	09/29/2020
Last Update Date	:	09/29/2020

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Directions to “ JAMARTA MERCEDES PORTER ” Practice Location

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