Provider Demographics
NPI:1477351716
Name:MARION, JESSICA L
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:MARION
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:10862 PORTAGE ST NW
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-8817
Mailing Address - Country:US
Mailing Address - Phone:330-408-7575
Mailing Address - Fax:330-408-7575
Practice Address - Street 1:10862 PORTAGE ST NW
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-8817
Practice Address - Country:US
Practice Address - Phone:330-408-7575
Practice Address - Fax:330-408-7575
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA011374225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant