Provider Demographics
NPI:1902940513
Name:PATTON, MARILYN SUE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:SUE
Last Name:PATTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SOUTH CHEYENNE STREET
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568
Mailing Address - Country:US
Mailing Address - Phone:217-824-4077
Mailing Address - Fax:
Practice Address - Street 1:121 SOUTH 6TH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:MARSHALL
Practice Address - State:IL
Practice Address - Zip Code:62441
Practice Address - Country:US
Practice Address - Phone:217-820-4077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist