Individual
MRS. MARISSA NAOMI TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
43 GROVE ST, PORTLAND, CT 06480-1956
(860) 508-4858
Mailing address
43 GROVE ST, PORTLAND, CT 06480-1956
(860) 508-4858
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
002371
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130002371CT01
ANTHEM PROVIDER ID
CT
Enumeration date
05/16/2007
Last updated
07/08/2007
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