Provider Demographics
NPI:1760363626
Name:ODINSSON, MARSHALL B
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:B
Last Name:ODINSSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 MIFFLIN AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3675
Mailing Address - Country:US
Mailing Address - Phone:617-820-1247
Mailing Address - Fax:
Practice Address - Street 1:1465 MIFFLIN AVE APT B
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3675
Practice Address - Country:US
Practice Address - Phone:617-820-1247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide