MEDICARE: MS. FAITH R 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	175T00000X	Peer Specialist	APS.004859	OH

General Provider Information

NPI Number	:	1700634037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FAITH R MARION

Provider Business Mailing Address
First Line	:	313 N WRIGHT AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-1638
Country	:	US
Telephone Number	:	937-977-5198
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 N WRIGHT AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-1638
Country	:	US
Telephone Number	:	937-977-5198
Fax Number	:

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

Provider Enumeration Date	:	05/10/2024
Last Update Date	:	05/10/2024

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