Provider Demographics
NPI:1639814312
Name:WOLF, MARSHA
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:
Other - Last Name:STRALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6744 ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:WALBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43465-9202
Mailing Address - Country:US
Mailing Address - Phone:419-266-4097
Mailing Address - Fax:
Practice Address - Street 1:6744 ALEXANDER DR
Practice Address - Street 2:
Practice Address - City:WALBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43465-9202
Practice Address - Country:US
Practice Address - Phone:419-266-4097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01OtherINDEPENDENT PROVIDER