Provider Demographics
NPI:1689440174
Name:WADLEY, MARLON
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:WADLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 EVERGREEN CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1385
Mailing Address - Country:US
Mailing Address - Phone:513-808-6440
Mailing Address - Fax:
Practice Address - Street 1:62 EVERGREEN CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1385
Practice Address - Country:US
Practice Address - Phone:513-808-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care