MEDICARE: TARRAH DANIELLE MARTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT004936	OH

General Provider Information

NPI Number	:	1295278976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARRAH DANIELLE MARTIN

Provider Business Mailing Address
First Line	:	2856 HYANNIS DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-2257
Country	:	US
Telephone Number	:	317-902-5074
Fax Number	:

Provider Business Practice Location Address
First Line	:	2856 HYANNIS DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-2257
Country	:	US
Telephone Number	:	317-902-5074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2016
Last Update Date	:	11/29/2016

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Directions to “ TARRAH DANIELLE MARTIN ” Practice Location

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