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1225997083 NPI number — MARISSA LOUISE BLACKWELDER

NPI Number: 1225997083
Health Care Provider/Practitioner: MARISSA LOUISE BLACKWELDER

Information about “1225997083” NPI (MARISSA LOUISE BLACKWELDER) exists in 1225997083 in HTML format HTML  |  1225997083 in plain Text format TXT  |  1225997083 in PDF (Portable Document Format) PDF  |  1225997083 in an XML format XML  formats.

NPI Number : 1225997083 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1225997083",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLACKWELDER",
    "FirstName": "MARISSA",
    "MiddleName": "LOUISE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "11816 TRINITY RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TRINITY",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27370-8300",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "707 N ELM ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HIGH POINT",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27262-3917",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "800-235-3645",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/19/2026",
    "LastUpdateDate": "01/19/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "224Z00000X",
        "TaxonomyName": "Occupational Therapy Assistant",
        "LicenseNumber": "17006",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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