Provider Demographics
NPI:1285102434
Name:MARVEL, ALLYSON JEANETTE (AT, ATC)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:JEANETTE
Last Name:MARVEL
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5161 DIO DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8933
Mailing Address - Country:US
Mailing Address - Phone:616-881-9028
Mailing Address - Fax:
Practice Address - Street 1:1434 W CHICAGO BLVD
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-8727
Practice Address - Country:US
Practice Address - Phone:517-424-8100
Practice Address - Fax:517-424-8200
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer