Provider Demographics
NPI:1023662624
Name:MARSAW, MYRA LASHOUN
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:LASHOUN
Last Name:MARSAW
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 1:7935 S WOOD ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-0491
Mailing Address - Country:US
Mailing Address - Phone:773-445-5841
Mailing Address - Fax:
Practice Address - Street 1:7935 S WOOD ST APT 2A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-0491
Practice Address - Country:US
Practice Address - Phone:773-445-5841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist