Provider Demographics
NPI:1245009307
Name:MARSH, TISHA
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:MARSH
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 1:8935 S STATE ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-9330
Mailing Address - Country:US
Mailing Address - Phone:937-218-1132
Mailing Address - Fax:
Practice Address - Street 1:8935 S STATE ROUTE 73
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-9330
Practice Address - Country:US
Practice Address - Phone:937-218-1132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach