Individual
MARISSA LYNNAE MAXHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
701 SHADWELL AVE, FLORA, IL 62839-2310
(618) 662-8361
Mailing address
702 SHADWELL AVE, FLORA, IL 62839-2309
(618) 842-4138
Taxonomy
Speciality
Code
Description
License number
State
2081H0002X
Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
160.008997
IL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
160008997
IL
Other
Enumeration date
06/18/2021
Last updated
06/18/2021
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