MEDICARE: MARISSA ANN ZOLTON 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
1	225X00000X	Occupational Therapist	5201010967	MI

General Provider Information

NPI Number	:	1265046635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA ANN ZOLTON OTD, OTR/L

Provider Business Mailing Address
First Line	:	647 MAYNARD AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-4629
Country	:	US
Telephone Number	:	260-750-9626
Fax Number	:	616-953-8926

Provider Business Practice Location Address
First Line	:	454 BAYPARK DR STE 10
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424
Country	:	US
Telephone Number	:	616-537-6613
Fax Number	:	616-953-8926

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2020
Last Update Date	:	02/02/2026

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