Provider Demographics
NPI:1164019816
Name:MADOX, MARLO YVETTE
Entity Type:Individual
Prefix:
First Name:MARLO
Middle Name:YVETTE
Last Name:MADOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARLO
Other - Middle Name:YVETTE
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24900 PICONE LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1953
Mailing Address - Country:US
Mailing Address - Phone:216-421-4363
Mailing Address - Fax:
Practice Address - Street 1:24900 PICONE LN
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1953
Practice Address - Country:US
Practice Address - Phone:216-421-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child