Healthcare Provider Details

I. General information

NPI: 1689892507
Provider Name (Legal Business Name): LISA M. MARSHALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W MORRIS BLVD SUITE 300
MORRISTOWN TN
37813-2283
US

IV. Provider business mailing address

PO BOX 1091
MORRISTOWN TN
37816-1091
US

V. Phone/Fax

Practice location:
  • Phone: 423-254-1978
  • Fax: 423-289-1072
Mailing address:
  • Phone: 423-254-1978
  • Fax: 423-289-1072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LISA M. MARSHALL
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MS, CCC-SLP
Phone: 423-254-1978