MEDICARE: AMY MARLIN ATC, L

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	174400000X	Specialist	AT2716	TX

General Provider Information

NPI Number	:	1275505927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MARLIN ATC, L

Provider Business Mailing Address
First Line	:	769 VILLA FLORES DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1526
Country	:	US
Telephone Number	:	915-842-0828
Fax Number	:	915-771-6914

Provider Business Practice Location Address
First Line	:	7800 EDGEMERE BLVD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-3835
Country	:	US
Telephone Number	:	915-780-1109
Fax Number	:	915-771-6914

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/08/2007

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