Provider Demographics
NPI:1912086570
Name:MARX, KODI (ATC, OT-SC)
Entity Type:Individual
Prefix:MISS
First Name:KODI
Middle Name:
Last Name:MARX
Suffix:
Gender:F
Credentials:ATC, OT-SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 PINERIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6538
Mailing Address - Country:US
Mailing Address - Phone:404-451-7682
Mailing Address - Fax:
Practice Address - Street 1:1014 SYCAMORE DR
Practice Address - Street 2:STE. B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1644
Practice Address - Country:US
Practice Address - Phone:404-299-1700
Practice Address - Fax:404-299-1616
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0006732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer