Provider Demographics
NPI:1871706705
Name:PACK, MARTHA J
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:PACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8069 CO RD 6
Mailing Address - Street 2:
Mailing Address - City:KITTS HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45645
Mailing Address - Country:US
Mailing Address - Phone:740-643-2546
Mailing Address - Fax:740-643-0164
Practice Address - Street 1:8069 CO RD 6
Practice Address - Street 2:
Practice Address - City:KITTS HILL
Practice Address - State:OH
Practice Address - Zip Code:45645
Practice Address - Country:US
Practice Address - Phone:740-643-2546
Practice Address - Fax:740-643-0164
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide