Healthcare Provider Details

I. General information

NPI: 1326773623
Provider Name (Legal Business Name): MARISSA MADDALENA OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA MADDALENA OTD, OTR/L

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W MEADOW DR
VAIL CO
81657-5242
US

IV. Provider business mailing address

PO BOX 40000
VAIL CO
81658-7520
US

V. Phone/Fax

Practice location:
  • Phone: 970-476-1225
  • Fax:
Mailing address:
  • Phone: 970-476-1225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: