Provider Demographics
NPI:1558681932
Name:STANLEY, MARISSA JADE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:JADE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:JADE
Other - Last Name:HULSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3424 HWY 9 SOUTH
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:AL
Mailing Address - Zip Code:36272-7035
Mailing Address - Country:US
Mailing Address - Phone:256-347-5206
Mailing Address - Fax:
Practice Address - Street 1:3331 HENRY RD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-6343
Practice Address - Country:US
Practice Address - Phone:256-499-1936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5395225X00000X
ALPTA 4888225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant