Healthcare Provider Details

I. General information

NPI: 1770405698
Provider Name (Legal Business Name): MARISSA ANN SCHMITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 RIDGE RD
LACKAWANNA NY
14218-1755
US

IV. Provider business mailing address

145 E MAIN ST
HAMBURG NY
14075-5132
US

V. Phone/Fax

Practice location:
  • Phone: 716-825-8644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number031285
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: