Individual
MARISSA LEE ELAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 948-2550
Mailing address
7116 FOXBOROUGH DR APT 3D, LAWRENCE, IN 46226-1212
(765) 716-3708
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36004117A
IN
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/08/2019
Last updated
01/23/2026
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