Provider Demographics
NPI:1588403216
Name:MARSH, BRITTANII FLORENE TAYLOR
Entity type:Individual
Prefix:
First Name:BRITTANII
Middle Name:FLORENE TAYLOR
Last Name:MARSH
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 1:209 BENDER ST
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-8081
Mailing Address - Country:US
Mailing Address - Phone:904-651-9270
Mailing Address - Fax:
Practice Address - Street 1:28 COASTAL MANOR DR
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316
Practice Address - Country:US
Practice Address - Phone:339-291-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002819224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant