Provider Demographics
NPI:1043236409
Name:CUPPETT, MARCHELL MARIE (ATC, EDD)
Entity Type:Individual
Prefix:DR
First Name:MARCHELL
Middle Name:MARIE
Last Name:CUPPETT
Suffix:
Gender:F
Credentials:ATC, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15210 AMBERLY DR
Mailing Address - Street 2:APT 2125
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2196
Mailing Address - Country:US
Mailing Address - Phone:813-974-7831
Mailing Address - Fax:813-974-2976
Practice Address - Street 1:12901 BRUCE B DOWNS BLVD
Practice Address - Street 2:MDC54
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4742
Practice Address - Country:US
Practice Address - Phone:813-974-7831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 14792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer