Provider Demographics
NPI:1295233468
Name:MARSHALL, MATTHEW (NMT-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:NMT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9063 BURTON AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND
Mailing Address - State:MO
Mailing Address - Zip Code:63114-4825
Mailing Address - Country:US
Mailing Address - Phone:314-409-0421
Mailing Address - Fax:
Practice Address - Street 1:2340 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2935
Practice Address - Country:US
Practice Address - Phone:314-647-2200
Practice Address - Fax:314-647-4172
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO167G00000X, 246Y00000X
156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information