Healthcare Provider Details

I. General information

NPI: 1285847046
Provider Name (Legal Business Name): MARSHALL COUNTY INFANT TODDLER SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N 4TH ST LINCOLN CENTER
MARYSVILLE KS
66508-1525
US

IV. Provider business mailing address

405 N 4TH ST LINCOLN CENTER
MARYSVILLE KS
66508-1525
US

V. Phone/Fax

Practice location:
  • Phone: 785-629-8300
  • Fax: 785-629-8388
Mailing address:
  • Phone: 785-629-8300
  • Fax: 785-629-8388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DONNA L HOLLE
Title or Position: FAMILY SERVICE COORDINATOR
Credential:
Phone: 785-629-8300