Provider Demographics
NPI:1083397582
Name:MARSHALL, MELISSA L
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 COUNTY ROAD 139
Mailing Address - Street 2:
Mailing Address - City:MC COMB
Mailing Address - State:OH
Mailing Address - Zip Code:45858-9413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2173 COUNTY ROAD 139
Practice Address - Street 2:
Practice Address - City:MC COMB
Practice Address - State:OH
Practice Address - Zip Code:45858-9413
Practice Address - Country:US
Practice Address - Phone:419-308-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker