Healthcare Provider Details

I. General information

NPI: 1972725802
Provider Name (Legal Business Name): MARTHA JOANNE JENIKE A.T.,C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. JODY JENIKE

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 BRIDGE POINT PASS
CINCINNATI OH
45248-1916
US

IV. Provider business mailing address

2056 STEGMAN AVE.
DAYTON OH
45404
US

V. Phone/Fax

Practice location:
  • Phone: 513-295-1756
  • Fax:
Mailing address:
  • Phone: 513-200-3111
  • Fax: 513-745-1963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT000072
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: