Provider Demographics
NPI:1285272245
Name:MUELLER, MARISA L (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:L
Last Name:MUELLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 NE SUNRISE TER
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-3885
Mailing Address - Country:US
Mailing Address - Phone:772-349-5438
Mailing Address - Fax:
Practice Address - Street 1:1360 NE SUNRISE TER
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-3885
Practice Address - Country:US
Practice Address - Phone:772-349-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15973225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist