Healthcare Provider Details

I. General information

NPI: 1932712908
Provider Name (Legal Business Name): MARISSA HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E DUBLIN GRANVILLE RD
WORTHINGTON OH
43085-3192
US

IV. Provider business mailing address

445 E DUBLIN GRANVILLE RD STE G
WORTHINGTON OH
43085-3183
US

V. Phone/Fax

Practice location:
  • Phone: 614-436-7837
  • Fax: 614-515-5779
Mailing address:
  • Phone: 614-436-7837
  • Fax: 614-515-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: