Provider Demographics
NPI:1932920931
Name:POALSON, MARISSA (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:POALSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4446 SANTINA WAY
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2198
Mailing Address - Country:US
Mailing Address - Phone:330-780-3228
Mailing Address - Fax:
Practice Address - Street 1:3805 EMERALD PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3317
Practice Address - Country:US
Practice Address - Phone:614-665-9844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT013059225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist