Healthcare Provider Details

I. General information

NPI: 1811814171
Provider Name (Legal Business Name): TERESA MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10979 REED HARTMAN HWY STE 304
BLUE ASH OH
45242-2825
US

IV. Provider business mailing address

3214 MANNING AVE
CINCINNATI OH
45211-6906
US

V. Phone/Fax

Practice location:
  • Phone: 513-341-6112
  • Fax:
Mailing address:
  • Phone: 513-254-6940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: