Individual
MARISSA DAWN WAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD
Contact information
Practice address
1611 W HARRISON ST STE 107, CHICAGO, IL 60612-4861
(877) 632-6637
(708) 409-5179
Mailing address
1611 W HARRISON ST STE 107, CHICAGO, IL 60612-4861
(877) 632-6637
(708) 409-5179
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056016126
IL
225X00000X
Occupational Therapist
31008447A
IN
Other
Enumeration date
05/27/2024
Last updated
07/25/2024
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