MEDICARE: WESLEY KARIN MARSH 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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1518788652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WESLEY KARIN MARSH BCBA

Provider Business Mailing Address
First Line	:	600 N LOOP 1604 E
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1268
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2370 NW MILITARY HWY APT 107
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-2507
Country	:	US
Telephone Number	:	203-832-7855
Fax Number	:

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

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	10/22/2024

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