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General NPI Number Information
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NPI Number | 1053109686
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Entity Type | Individual
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Provider Name | MARISSA RENELLA MT-BC, MTL
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Gender | Female
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 4033 E MADISON ST STE 108
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City | SEATTLE
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State | WA
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Zip | 98112-3104
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Country | US
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Telephone | 206-438-4068
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Fax |
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Provider Business Mailing Address
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Address Line | 2506 WETMORE AVE APT A
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City | EVERETT
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State | WA
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Zip | 98201-2920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | MU61651326
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License Number State | WA
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