Provider Demographics
NPI:1437757549
Name:SEXTON, MARISSA ELAINE (ATC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ELAINE
Last Name:SEXTON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MRS
Other - First Name:MARISSA
Other - Middle Name:ELAINE
Other - Last Name:WHITTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:MTSU BOX 77
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37132-0001
Mailing Address - Country:US
Mailing Address - Phone:615-904-8303
Mailing Address - Fax:615-904-8301
Practice Address - Street 1:1500 GREENLAND DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37132-3100
Practice Address - Country:US
Practice Address - Phone:615-904-8303
Practice Address - Fax:615-904-8301
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000024442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer