Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OTT.Z12357 | LA |
NPI | 1538126909 |
---|---|
Provider Name | Mr. Michael Joseph Marshall |
First Address | Greeneville, TN 37743-5452 |
Second Address | Mountain Home, TN 37684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 30/01/2009 |