Individual
MARISSA GAYLE TALBOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
4414 PHEASANT RIDGE RD, ROANOKE, VA 24014-5276
(540) 492-5455
Mailing address
3270 FLEETWOOD AVE, ROANOKE, VA 24015-4644
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131001823
VA
Other
Enumeration date
06/14/2018
Last updated
06/14/2018
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