Provider Demographics
NPI:1235360728
Name:MARINO, MICHELE SUE (PTA)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:SUE
Last Name:MARINO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 COLONY PARK DR
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2859
Mailing Address - Country:US
Mailing Address - Phone:330-634-0973
Mailing Address - Fax:
Practice Address - Street 1:563 COLONY PARK DR
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2859
Practice Address - Country:US
Practice Address - Phone:330-634-0973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist