Provider Demographics
NPI:1215145271
Name:MARSTILLER, AMANDA CATHERINE
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CATHERINE
Last Name:MARSTILLER
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 1:327 MULBERRY WAY W
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-1096
Mailing Address - Country:US
Mailing Address - Phone:614-778-0997
Mailing Address - Fax:
Practice Address - Street 1:315 SLATE RUN DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8933
Practice Address - Country:US
Practice Address - Phone:740-548-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2132374Medicaid