Individual
JEREMY SCOTT MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2481 N.E. COACHMAN RD, CLEARWATER, FL 33765
(727) 797-9756
Mailing address
PO BOX 3146, PINELLAS PARK, FL 33780-3146
(727) 276-2579
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021020300
—
FL
Enumeration date
06/20/2018
Last updated
06/20/2018
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