MEDICARE: MS. MARTHA JOANNE JENIKE A.T.,C.

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	AT000072	OH

General Provider Information

NPI Number	:	1972725802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA JOANNE JENIKE A.T.,C.

Provider Business Mailing Address
First Line	:	2056 STEGMAN AVE.
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45404
Country	:	US
Telephone Number	:	513-200-3111
Fax Number	:	513-745-1963

Provider Business Practice Location Address
First Line	:	7430 BRIDGE POINT PASS
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-1916
Country	:	US
Telephone Number	:	513-295-1756
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/26/2022

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