Provider Demographics
NPI:1225684061
Name:MARMON, GINGER SUE
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:SUE
Last Name:MARMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AJM
Other - Middle Name:LIFT
Other - Last Name:SERVICES LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:410 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-2121
Mailing Address - Country:US
Mailing Address - Phone:419-204-0453
Mailing Address - Fax:
Practice Address - Street 1:410 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-2121
Practice Address - Country:US
Practice Address - Phone:419-204-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver