MEDICARE: DR. THOMAS O. MARTIN PH.D.

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	103TC0700X	Clinical Psychologist	3011	OH
2	103TF0200X	Forensic Psychologist	3011	OH

General Provider Information

NPI Number	:	1770634198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS O. MARTIN PH.D.

Provider Business Mailing Address
First Line	:	5621 SAVINA AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-1155
Country	:	US
Telephone Number	:	937-231-2699
Fax Number	:

Provider Business Practice Location Address
First Line	:	5621 SAVINA AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-1155
Country	:	US
Telephone Number	:	937-231-2699
Fax Number	:

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

Provider Enumeration Date	:	01/13/2007
Last Update Date	:	09/11/2025

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