MEDICARE: MARVELLES APPAREL INC

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1659374916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARVELLES APPAREL INC

Provider Business Mailing Address
First Line	:	1804 S. BRDWY, STE 160
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308
Country	:	US
Telephone Number	:	320-762-2439
Fax Number	:	320-762-2622

Provider Business Practice Location Address
First Line	:	1804 S. BROADWAY, STE #160
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308
Country	:	US
Telephone Number	:	320-762-2439
Fax Number	:	320-762-2622

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARVELLE MARIE WEISPFENNIG
Credential	:	CMF
Telephone Number	:	320-762-2439

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/14/2010

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Directions to “MARVELLES APPAREL INC ” Practice Location

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