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General NPI Number Information
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NPI Number | 1205288016
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Entity Type | Individual
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Provider Name | MARISSA HOWK
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Gender | Female
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 128 ASH ST APT 3
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City | CALIFORNIA
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State | PA
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Zip | 15419-2004
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Country | US
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Telephone | 301-653-4979
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Fax |
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Provider Business Mailing Address
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Address Line | 4607 WATERVIEW CT UNIT 8
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City | JB ANDREWS
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State | MD
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Zip | 20762-5351
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Country | US
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Telephone | 301-653-4979
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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