Provider Demographics
NPI:1275710162
Name:MARSHALL, GREGORY RUSSELL (MOTR/L)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:RUSSELL
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6100 KENNERLY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4368
Mailing Address - Country:US
Mailing Address - Phone:904-739-9757
Mailing Address - Fax:904-448-5501
Practice Address - Street 1:6100 KENNERLY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4368
Practice Address - Country:US
Practice Address - Phone:904-739-9757
Practice Address - Fax:904-448-5501
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist