Healthcare Provider Details

I. General information

NPI: 1124943667
Provider Name (Legal Business Name): MARISSA EMIKO SIU OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9461 SOARING OAKS DR
ELK GROVE CA
95758-1075
US

IV. Provider business mailing address

9461 SOARING OAKS DR
ELK GROVE CA
95758-1075
US

V. Phone/Fax

Practice location:
  • Phone: 916-683-3073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: