=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629617162
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANNAH MARTIN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/01/2020
-----------------------------------------------------
Last Update Date | 01/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1991 CROCKER RD STE 600
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145-6976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-644-6220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36550 CHESTER RD APT 3908
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44011-4011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HANNAH MARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-644-6220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------