MEDICARE: MARSH CREEK MYOFUNCTIONAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1407781412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSH CREEK MYOFUNCTIONAL THERAPY LLC

Provider Business Mailing Address
First Line	:	5 SALISBURY CT
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31410-3911
Country	:	US
Telephone Number	:	912-677-9405
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 SALISBURY CT
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31410-3911
Country	:	US
Telephone Number	:	912-677-9405
Fax Number	:

Authorized Official
Title or Position	:	MYOFUNCTIONAL THERAPIST
Name	:	KELLEY FRIGO
Credential	:	RDH
Telephone Number	:	912-677-0160

Provider Enumeration Date	:	06/13/2026
Last Update Date	:	06/13/2026

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