Provider Demographics
NPI:1285489633
Name:MEINEMA, MARISSA P (OTR/L)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:P
Last Name:MEINEMA
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 1:129 GARDENER WAY
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8919
Mailing Address - Country:US
Mailing Address - Phone:517-404-0204
Mailing Address - Fax:
Practice Address - Street 1:129 GARDENER WAY
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8919
Practice Address - Country:US
Practice Address - Phone:517-404-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005184225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist