Provider Demographics
NPI:1467651794
Name:MARLEY, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 S PARKER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-3593
Mailing Address - Country:US
Mailing Address - Phone:810-765-8110
Mailing Address - Fax:810-765-9811
Practice Address - Street 1:540 S PARKER ST
Practice Address - Street 2:SUITE B
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-3593
Practice Address - Country:US
Practice Address - Phone:810-765-8110
Practice Address - Fax:810-765-9811
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant