Provider Demographics
NPI:1720108475
Name:MARSHALL, KINA L (RECREATION THERAPIST)
Entity Type:Individual
Prefix:
First Name:KINA
Middle Name:L
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RECREATION THERAPIST
Other - Prefix:
Other - First Name:KINA
Other - Middle Name:L
Other - Last Name:ATKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RECREATIONAL THERAPI
Mailing Address - Street 1:1100 BLYTHE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5814
Mailing Address - Country:US
Mailing Address - Phone:704-355-8484
Mailing Address - Fax:704-355-4231
Practice Address - Street 1:1100 BLYTHE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5814
Practice Address - Country:US
Practice Address - Phone:704-355-8484
Practice Address - Fax:704-355-4231
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1615225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist