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General NPI Number Information
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NPI Number | 1831061647
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Entity Type | Individual
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Provider Name | MARISSA ASHLEY BRINK MSOTRL
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Gender | Female
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | PO BOX 43
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City | FACTORYVILLE
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State | PA
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Zip | 18419-0043
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Country | US
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Telephone | 570-561-6639
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Fax |
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Provider Business Mailing Address
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Address Line | 198 BARNEY ST
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City | WILKES BARRE
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State | PA
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Zip | 18702-3414
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Country | US
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Telephone | 570-637-7935
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OC021080
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License Number State | PA
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