MEDICARE: ELYSSE M MARION

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1235432238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELYSSE M MARION

Provider Business Mailing Address
First Line	:	245 E CENTENNIAL PKWY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-1354
Country	:	US
Telephone Number	:	702-544-8747
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 E CENTENNIAL PKWY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-1354
Country	:	US
Telephone Number	:	702-544-8747
Fax Number	:

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

Provider Enumeration Date	:	12/13/2010
Last Update Date	:	12/13/2010

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Directions to “ ELYSSE M MARION ” Practice Location

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