Individual
MARISSA KATHERINE WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
28 MAPLE AVE, COHOCTON, NY 14826-9998
(585) 704-1624
Mailing address
3 PARK AVE, COHOCTON, NY 14826-9401
(585) 944-8700
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
030654
NY
Other
Enumeration date
10/30/2018
Last updated
10/30/2018
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