MEDICARE: MARLIN DEAN ELLIOTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	T69881924	VA

General Provider Information

NPI Number	:	1003774175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLIN DEAN ELLIOTT

Provider Business Mailing Address
First Line	:	1125 COMMERCE RD APT 103
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-7523
Country	:	US
Telephone Number	:	804-247-5814
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 COMMERCE RD APT 103
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-7523
Country	:	US
Telephone Number	:	804-247-5814
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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Directions to “ MARLIN DEAN ELLIOTT ” Practice Location

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