Most Relevant Information
Provider Data
| NPI Number: | 1003302613 |
| Provider Name: | MARSHA T RUSSELL CDCA |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/06/2018 |
| Last Updated: | 09/27/2021 |
Provider Practice Location
4977 NORTHCUTT PL
DAYTON
OH
454143839
Practice Location Phone/Fax
| Phone: | 9373876395 |
| Fax: |
Provider Mailing Location
4748 TENSHAW DR
DAYTON
OH
454175930
Provider Mailing Phone/Fax
| Phone: | 9372665702 |
| Fax: |