Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | SS796 | FL |
NPI | 1023262458 |
---|---|
Provider Name | Dr. Krista Michiels Marchman |
First Address | Celebration, FL 34747-5159 |
Second Address | Celebration, FL 34747-5159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2008 |
Last Update Date | 12/11/2008 |