Provider Demographics
NPI:1154447027
Name:STEVENS, MARSHA K
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:K
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525 CO. RD. 5
Mailing Address - Street 2:
Mailing Address - City:PEDRO
Mailing Address - State:OH
Mailing Address - Zip Code:45659-9074
Mailing Address - Country:US
Mailing Address - Phone:740-643-1910
Mailing Address - Fax:740-643-1910
Practice Address - Street 1:6525 CO. RD. 5
Practice Address - Street 2:
Practice Address - City:PEDRO
Practice Address - State:OH
Practice Address - Zip Code:45659-9074
Practice Address - Country:US
Practice Address - Phone:740-643-1910
Practice Address - Fax:740-643-1910
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2646551Medicaid