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NPI Code Detail

MEDICARE: MARISSA DENT OTD, OTR/L

MEDICARE: MARISSA DENT OTD, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOTR3615AR

General Provider Information

NPI Number : 1245999234
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISSA DENT OTD, OTR/L
Provider Business Mailing Address
First Line : 2520 W MAIN ST
Second Line :
City : JACKSONVILLE
State : AR
Zip : 72076-4214
Country : US
Telephone Number : 501-982-0528
Fax Number : 501-533-6326
Provider Business Practice Location Address
First Line : 905 N REDMOND RD
Second Line :
City : JACKSONVILLE
State : AR
Zip : 72076-3622
Country : US
Telephone Number : 501-982-0528
Fax Number : 501-533-6326
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2021
Last Update Date : 12/17/2021

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Directions to “ MARISSA DENT OTD, OTR/L” Practice Location

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