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General NPI Number Information
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NPI Number | 1750824835
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Entity Type | Organization
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Legal Business Name | EARLINE MARCHELLO
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 1190 E 5425 S
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4548
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Country | US
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Telephone | 385-238-9806
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13825
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City | OGDEN
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State | UT
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Zip | 84412-3825
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Country | US
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Telephone | 385-238-9806
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST/OWNER
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Name | CINDY EARLINE MARCHELLO
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Credential | LAC
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Telephone | 358-238-9806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 352031 1201
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License Number State | UT
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