Provider Demographics
NPI:1346599099
Name:AUSTIN, MARCIA (CTRS)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 NEEDMORE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6107
Mailing Address - Country:US
Mailing Address - Phone:931-368-8531
Mailing Address - Fax:
Practice Address - Street 1:441 NEEDMORE RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6107
Practice Address - Country:US
Practice Address - Phone:931-368-8531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-09
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
55135OtherNATIONAL COUNCIL FOR THERAPEUTIC RECREATION CERTIFICATION