Healthcare Provider Details

I. General information

NPI: 1164694386
Provider Name (Legal Business Name): SUSAN M. MARTIN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

3200 VINE ST
CINCINNATI OH
45220-2213
US

V. Phone/Fax

Practice location:
  • Phone: 513-861-3100
  • Fax: 513-487-6657
Mailing address:
  • Phone: 513-861-3100
  • Fax: 513-487-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA01281
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: