Provider Demographics
NPI:1205020872
Name:LAND, MARISHA AILEEN (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:MARISHA
Middle Name:AILEEN
Last Name:LAND
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BRICKSTONE SQ
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1437
Mailing Address - Country:US
Mailing Address - Phone:978-474-7500
Mailing Address - Fax:
Practice Address - Street 1:4025 N SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-4975
Practice Address - Country:US
Practice Address - Phone:704-569-9661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6610224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant