Healthcare Provider Details

I. General information

NPI: 1558738070
Provider Name (Legal Business Name): MARISSA BLAND M.S., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 EDMONDS ST
ROCHESTER NY
14607-3701
US

IV. Provider business mailing address

35 EDMONDS ST
ROCHESTER NY
14607-3701
US

V. Phone/Fax

Practice location:
  • Phone: 585-690-0709
  • Fax:
Mailing address:
  • Phone: 585-690-0709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number019981-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: