Provider Demographics
NPI:1124689435
Name:JUSTICE, MARISA CHRISTINE (OTR/L)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:CHRISTINE
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:CHRISTINE
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5870 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4510
Mailing Address - Country:US
Mailing Address - Phone:513-503-0288
Mailing Address - Fax:
Practice Address - Street 1:10800 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-8969
Practice Address - Country:US
Practice Address - Phone:513-503-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist