MEDICARE: MRS. MARCIA ANN GARRISON

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	385H00000X	Respite Care

General Provider Information

NPI Number	:	1245553122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCIA ANN GARRISON

Provider Business Mailing Address
First Line	:	2339 JEFFERSON RD
Second Line	:
City	:	CLARKLAKE
State	:	MI
Zip	:	49234
Country	:	US
Telephone Number	:	517-529-1088
Fax Number	:	517-529-1088

Provider Business Practice Location Address
First Line	:	2339 JEFFERSON RD.
Second Line	:
City	:	CLARKLAKE
State	:	MI
Zip	:	49234
Country	:	US
Telephone Number	:	517-529-1088
Fax Number	:	517-529-1088

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

Provider Enumeration Date	:	03/08/2010
Last Update Date	:	03/08/2010

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