Individual
MARISSA CALLICOTTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8765 LEWIS AVE, TEMPERANCE, MI 48182-9300
(734) 654-2169
Mailing address
120 MARSHALL DR, SWANTON, OH 43558-1422
(567) 694-9394
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
50.006009RX
OH
363A00000X
Physician Assistant
Primary
5601009570
MI
Other
Enumeration date
06/24/2019
Last updated
07/29/2019
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