Provider Demographics
NPI:1003433632
Name:KITT, MARISA (OTR)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:KITT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 MADISON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5093
Mailing Address - Country:US
Mailing Address - Phone:317-851-8419
Mailing Address - Fax:317-851-8499
Practice Address - Street 1:6825 MADISON AVE STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5093
Practice Address - Country:US
Practice Address - Phone:317-851-8419
Practice Address - Fax:317-851-8499
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007039A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist