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NPI Code Detail

MEDICARE: MRS. HEATHER LYNN MARSHALL BCBA

MEDICARE: MRS. HEATHER LYNN MARSHALL BCBA
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
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114350741
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HEATHER LYNN MARSHALL BCBA
Provider Business Mailing Address
First Line : 126 TALL OAKS RD
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32435-8975
Country : US
Telephone Number : 850-585-9189
Fax Number :
Provider Business Practice Location Address
First Line : 171 STATE HIGHWAY 83
Second Line : UNIT A101
City : DEFUNIAK SPRINGS
State : FL
Zip : 32433-7427
Country : US
Telephone Number : 850-585-9189
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2013
Last Update Date : 02/09/2016

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