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Individual

MARRISSA TACKETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
10483 DIXIE HWY, HOLLY, MI 48442-9311
(734) 657-2054
Mailing address
10483 DIXIE HWY, HOLLY, MI 48442-9311

Taxonomy

Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
69608
MI

Other

Enumeration date
11/14/2017
Last updated
11/14/2017
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