Healthcare Provider Details

I. General information

NPI: 1457792202
Provider Name (Legal Business Name): MRS. MARLA CLAIRE CISSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MARLA CLAIRE LACE

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E UNION AVE
OSCEOLA AR
72370-3235
US

IV. Provider business mailing address

315 E UNION AVE
OSCEOLA AR
72370-3235
US

V. Phone/Fax

Practice location:
  • Phone: 870-563-1331
  • Fax: 870-563-1211
Mailing address:
  • Phone: 870-563-1331
  • Fax: 870-563-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: