Provider Demographics
NPI:1013306729
Name:MARSHALL, CONSTANCE HOPE (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:HOPE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 JORDAN SUMRALL RD
Mailing Address - Street 2:
Mailing Address - City:BUCKATUNNA
Mailing Address - State:MS
Mailing Address - Zip Code:39322-9630
Mailing Address - Country:US
Mailing Address - Phone:601-410-0620
Mailing Address - Fax:
Practice Address - Street 1:1036 WEST DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4706
Practice Address - Country:US
Practice Address - Phone:601-425-3191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2573225X00000X, 225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology