Provider Demographics
NPI:1417299587
Name:ORCHARD, MARISSA KAE (CMT, RMT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:KAE
Last Name:ORCHARD
Suffix:
Gender:F
Credentials:CMT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 S LEMAY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1295
Mailing Address - Country:US
Mailing Address - Phone:970-286-0033
Mailing Address - Fax:
Practice Address - Street 1:1918 S LEMAY AVE STE A
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1295
Practice Address - Country:US
Practice Address - Phone:970-286-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0012420225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist