Provider Demographics
NPI:1174977706
Name:RAY, MARTIN
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9741 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6130
Mailing Address - Country:US
Mailing Address - Phone:513-793-9333
Mailing Address - Fax:513-793-5424
Practice Address - Street 1:9741 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6130
Practice Address - Country:US
Practice Address - Phone:513-793-9333
Practice Address - Fax:513-793-5424
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03003237700000X
KYHISHSP00218693237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist