Provider Demographics
NPI:1821152216
Name:MARION, TAMMY
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:
Last Name:MARION
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 1:69 CHESTER GROOMS RD
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693
Mailing Address - Country:US
Mailing Address - Phone:937-544-8525
Mailing Address - Fax:
Practice Address - Street 1:69 CHESTER GROOMS RD
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-9560
Practice Address - Country:US
Practice Address - Phone:937-544-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2300003Medicaid