Provider Demographics
NPI:1578523841
Name:MARSH, LYNDA GAIL (BOCO, LO)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:GAIL
Last Name:MARSH
Suffix:
Gender:F
Credentials:BOCO, LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 CLIFFBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5710
Mailing Address - Country:US
Mailing Address - Phone:469-360-1172
Mailing Address - Fax:972-242-4253
Practice Address - Street 1:2809 CLIFFBROOK DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5710
Practice Address - Country:US
Practice Address - Phone:469-360-1172
Practice Address - Fax:972-242-4253
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist