Provider Demographics
NPI:1013186204
Name:KING, MARISA DAWN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:DAWN
Last Name:KING
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:D
Other - Last Name:LEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:15 TURNER RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MA
Mailing Address - Zip Code:01469-1368
Mailing Address - Country:US
Mailing Address - Phone:978-597-0908
Mailing Address - Fax:
Practice Address - Street 1:497 MAIN ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1298
Practice Address - Country:US
Practice Address - Phone:978-448-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7901225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist