Provider Demographics
NPI:1215117619
Name:MARCHISIN, KIMBERLY LYNN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNN
Last Name:MARCHISIN
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 1:10 E JORDAN ST WEST
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712
Mailing Address - Country:US
Mailing Address - Phone:828-877-2667
Mailing Address - Fax:828-877-6699
Practice Address - Street 1:10 E JORDAN ST WEST
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712
Practice Address - Country:US
Practice Address - Phone:828-877-2667
Practice Address - Fax:828-877-6699
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter