Individual
MISS MARISSA NICOLE LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1000 STACIE DR, HAZLETON, PA 18201-5690
(570) 453-5100
Mailing address
1000 STACIE DR, HAZLETON, PA 18201-5690
(570) 453-5100
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP008829
PA
Other
Enumeration date
10/26/2017
Last updated
10/26/2017
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