Individual
MARISSA ELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
12355 W COCOPAH ST, AVONDALE, AZ 85323-3120
(717) 261-7319
Mailing address
12355 W COCOPAH ST, AVONDALE, AZ 85323-3120
(717) 261-7319
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
6720
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6720
AZ BOARD OF OT LICENSE
AZ
Enumeration date
11/07/2016
Last updated
11/07/2016
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