Provider Demographics
NPI:1740002724
Name:MARVEL, TERESA KELLY (CTRS)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:KELLY
Last Name:MARVEL
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 GARY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21087-1040
Mailing Address - Country:US
Mailing Address - Phone:443-243-9038
Mailing Address - Fax:
Practice Address - Street 1:2 HAMILL RD STE 320
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1813
Practice Address - Country:US
Practice Address - Phone:443-595-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD52938225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist