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Individual

MARK MARBLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CTRS

Contact information

Practice address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 362-4471
Mailing address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116

Taxonomy

Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
27057
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
27057
NATIONAL COUNCIL FOR THERAPEUTIC RECREATION CERTIFICATION
Enumeration date
03/15/2017
Last updated
03/15/2017
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