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NPI Code Detail

MEDICARE: MRS. MARISSA DAWN SCHMITZ

MEDICARE: MRS. MARISSA DAWN SCHMITZ
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
1171M00000XCase Manager/Care Coordinator
2106S00000XBehavior TechnicianRBT-23-R285080OK

General Provider Information

NPI Number : 1417662867
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARISSA DAWN SCHMITZ
Provider Business Mailing Address
First Line : 4515 E 91ST ST
Second Line :
City : TULSA
State : OK
Zip : 74137-2861
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4515 E 91ST ST
Second Line :
City : TULSA
State : OK
Zip : 74137-2861
Country : US
Telephone Number : 720-207-8637
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2023
Last Update Date : 09/20/2023

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Directions to “ MRS. MARISSA DAWN SCHMITZ ” Practice Location

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