Provider Demographics
NPI:1932512472
Name:JARVIS-ROLFING, MARIE (MOT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:JARVIS-ROLFING
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W 14TH ST UNIT C1
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5100
Mailing Address - Country:US
Mailing Address - Phone:970-903-0098
Mailing Address - Fax:
Practice Address - Street 1:128 W 14TH ST UNIT C1
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5100
Practice Address - Country:US
Practice Address - Phone:970-903-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0002396174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist