Healthcare Provider Details

I. General information

NPI: 1588568638
Provider Name (Legal Business Name): MARISSA KNOPF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 5TH ST
FULTON MO
65251-1793
US

IV. Provider business mailing address

9019 STATE ROAD NN
FULTON MO
65251-7169
US

V. Phone/Fax

Practice location:
  • Phone: 573-592-3340
  • Fax:
Mailing address:
  • Phone: 573-592-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: