Provider Demographics
NPI:1386963601
Name:ROUSSEY, MARITA (AP, OMD)
Entity type:Individual
Prefix:DR
First Name:MARITA
Middle Name:
Last Name:ROUSSEY
Suffix:
Gender:F
Credentials:AP, OMD
Other - Prefix:DR
Other - First Name:MARITA
Other - Middle Name:
Other - Last Name:KUFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, OMD
Mailing Address - Street 1:2750 STICKNEY POINT RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-6017
Mailing Address - Country:US
Mailing Address - Phone:941-923-2203
Mailing Address - Fax:941-923-2290
Practice Address - Street 1:2750 STICKNEY POINT RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6017
Practice Address - Country:US
Practice Address - Phone:941-923-2203
Practice Address - Fax:941-923-2290
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP647171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist