Healthcare Provider Details

I. General information

NPI: 1295956894
Provider Name (Legal Business Name): DANA MARLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3324 FRONTIER TRAIL
LOUISVILLE KY
40220-2654
US

IV. Provider business mailing address

234 MUSSEL LANE
SHELBYVILLE KY
40065-8922
US

V. Phone/Fax

Practice location:
  • Phone: 502-435-6316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: