MEDICARE: ALVIN MARSHALL RBT

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	106S00000X	Behavior Technician	RBT-18-61747

General Provider Information

NPI Number	:	1700365608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALVIN MARSHALL RBT

Provider Business Mailing Address
First Line	:	770 E PORTLAND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2755
Country	:	US
Telephone Number	:	530-961-3129
Fax Number	:

Provider Business Practice Location Address
First Line	:	6232 N 7TH ST STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-1850
Country	:	US
Telephone Number	:	623-693-4820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2018
Last Update Date	:	08/10/2018

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