MEDICARE: MARISSA SCHWAB MSOT, 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	225XP0200X	Pediatric Occupational Therapist	2021010858	MO
2	225X00000X	Occupational Therapist	2021010858	MO

General Provider Information

NPI Number	:	1639826597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA SCHWAB MSOT, OTR/L

Provider Business Mailing Address
First Line	:	3488 JEFFCO BLVD STE 102
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-6015
Country	:	US
Telephone Number	:	636-464-5439
Fax Number	:	636-464-5438

Provider Business Practice Location Address
First Line	:	3488 JEFFCO BLVD STE 102
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-6015
Country	:	US
Telephone Number	:	636-464-5439
Fax Number	:

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

Provider Enumeration Date	:	03/09/2022
Last Update Date	:	06/08/2026

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