Provider Demographics
NPI:1891269015
Name:DEHMEL, MARISA LYNNE (MSOT OTRL)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:LYNNE
Last Name:DEHMEL
Suffix:
Gender:F
Credentials:MSOT OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 DELTA RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9341
Mailing Address - Country:US
Mailing Address - Phone:989-414-0864
Mailing Address - Fax:
Practice Address - Street 1:3520 W VIENNA RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-2034
Practice Address - Country:US
Practice Address - Phone:844-854-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 225X00000X
MI5201013298225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician