Healthcare Provider Details

I. General information

NPI: 1972150563
Provider Name (Legal Business Name): MARTA BOOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 RIVERSIDE DR STE 200
COLUMBUS OH
43221-2547
US

IV. Provider business mailing address

3070 RIVERSIDE DR STE 200
COLUMBUS OH
43221-2547
US

V. Phone/Fax

Practice location:
  • Phone: 614-615-5145
  • Fax:
Mailing address:
  • Phone: 614-615-5145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: