Healthcare Provider Details

I. General information

NPI: 1225961139
Provider Name (Legal Business Name): MARISSA R MCSHEPARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

4770 INDIANOLA AVE
COLUMBUS OH
43214-1862
US

IV. Provider business mailing address

5692 BIXBYWOODS CT APT C
COLUMBUS OH
43232-2555
US

V. Phone/Fax

Practice location:
  • Phone: 220-228-0124
  • Fax:
Mailing address:
  • Phone: 216-527-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: