Individual
MARISSA JASMINE WEBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1222 BURLINGTON ST, MENDOTA, IL 61342-1506
(815) 993-6454
Mailing address
1222 BURLINGTON ST, MENDOTA, IL 61342-1506
(815) 993-6454
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057005052
IL
Other
Enumeration date
12/09/2020
Last updated
12/09/2020
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