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General NPI Number Information
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NPI Number | 1942639257
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Entity Type | Individual
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Provider Name | MARISSA INGRAM OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 910 E CHURCH ST
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City | MARION
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State | OH
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Zip | 43302-4317
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Country | US
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Telephone | 740-387-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 2790 NEIDHART RD
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City | MARION
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State | OH
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Zip | 43302-8443
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Country | US
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Telephone | 740-251-3752
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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 | OT012813
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License Number State | OH
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