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General NPI Number Information
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NPI Number | 1841417052
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Entity Type | Individual
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Provider Name | MA. MARISSA REMOLANA ACHARON OTR/L,CLT
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 03/31/2018
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Provider Practice Location Address
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Address Line | 304 W MAPLE AVENUE
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City | AUBURN
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State | IL
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Zip | 62615
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Country | US
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Telephone | 217-438-6125
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Fax |
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Provider Business Mailing Address
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Address Line | 304 W MAPLE AVE
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City | AUBURN
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State | IL
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Zip | 62615-1177
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Country | US
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Telephone | 217-438-6125
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 16339
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2004014249
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056.007318
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License Number State | IL
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