Provider Demographics
NPI:1801789698
Name:MARSHALL, GWEN J (OTR)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:J
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:PIERZ
Mailing Address - State:MN
Mailing Address - Zip Code:56364-0475
Mailing Address - Country:US
Mailing Address - Phone:320-468-7199
Mailing Address - Fax:320-310-0254
Practice Address - Street 1:221 MAIN ST N
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364-1570
Practice Address - Country:US
Practice Address - Phone:320-468-7199
Practice Address - Fax:320-310-0254
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103669225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist