Provider Demographics
NPI:1588101141
Name:FERL, MARISSA JAE (MT-BC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:JAE
Last Name:FERL
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15010 TERRA RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-6114
Mailing Address - Country:US
Mailing Address - Phone:719-492-5282
Mailing Address - Fax:
Practice Address - Street 1:15010 TERRA RIDGE CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-6114
Practice Address - Country:US
Practice Address - Phone:719-492-5282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist