Provider Demographics
NPI:1871814152
Name:MARTINO, TABATHA LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:TABATHA
Middle Name:LYNN
Last Name:MARTINO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:TABATHA
Other - Middle Name:LYNN
Other - Last Name:PEASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:248 HIGH ST NW
Mailing Address - Street 2:
Mailing Address - City:EAST CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44730-1032
Mailing Address - Country:US
Mailing Address - Phone:330-268-7260
Mailing Address - Fax:
Practice Address - Street 1:248 HIGH ST NW
Practice Address - Street 2:
Practice Address - City:EAST CANTON
Practice Address - State:OH
Practice Address - Zip Code:44730-1032
Practice Address - Country:US
Practice Address - Phone:330-268-7260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN135850IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse