Individual
MARISSA ANNE BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
1108 VALLEY DR, PAOLA, KS 66071-1148
(913) 731-3093
Mailing address
1108 VALLEY DR, PAOLA, KS 66071-1148
(913) 731-3093
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18-01728
KS
Other
Enumeration date
03/29/2021
Last updated
03/29/2021
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