Provider Demographics
NPI:1306015011
Name:DONNELL, MARISA PALMER (LMT, NCTMB)
Entity Type:Individual
Prefix:MISS
First Name:MARISA
Middle Name:PALMER
Last Name:DONNELL
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 102ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-3240
Mailing Address - Country:US
Mailing Address - Phone:239-919-6573
Mailing Address - Fax:
Practice Address - Street 1:871 102ND AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-3240
Practice Address - Country:US
Practice Address - Phone:239-919-6573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA535410-07225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist