Provider Demographics
NPI:1154881084
Name:KOHRHERR, MARISSA ARIEL (ATC, LAT, ITAT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ARIEL
Last Name:KOHRHERR
Suffix:
Gender:F
Credentials:ATC, LAT, ITAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DELAWARE DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-1615
Mailing Address - Country:US
Mailing Address - Phone:856-275-8586
Mailing Address - Fax:
Practice Address - Street 1:213 GREENHILL AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1844
Practice Address - Country:US
Practice Address - Phone:302-658-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002433002255A2300X
PART0069232255A2300X
20000282692255A2300X
DEJ3-00006862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer