Provider Demographics
NPI:1235322140
Name:BLUM, MARLA KAY (INDEPENT PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:KAY
Last Name:BLUM
Suffix:
Gender:F
Credentials:INDEPENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 LAWHEAD LN
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-6972
Mailing Address - Country:US
Mailing Address - Phone:740-452-4030
Mailing Address - Fax:
Practice Address - Street 1:1860 LAWHEAD LN
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-6972
Practice Address - Country:US
Practice Address - Phone:740-452-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2711800175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2711800OtherINDEPENT PROVIDER