MEDICARE: MARISSA MONSON OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1174262786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA MONSON OTR/L

Provider Business Mailing Address
First Line	:	10001 PARK ST
Second Line	:
City	:	SOUTH WAYNE
State	:	WI
Zip	:	53587-9601
Country	:	US
Telephone Number	:	608-482-4795
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 EASTSIDE RD
Second Line	:
City	:	PLATTEVILLE
State	:	WI
Zip	:	53818-9800
Country	:	US
Telephone Number	:	608-348-2331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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