Provider Demographics
NPI:1609407279
Name:MITCHELL, MARISSA ANN (LMT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3324
Mailing Address - Country:US
Mailing Address - Phone:304-646-1333
Mailing Address - Fax:844-587-9617
Practice Address - Street 1:1991 STADIUM DR
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3324
Practice Address - Country:US
Practice Address - Phone:304-646-1333
Practice Address - Fax:844-587-9617
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2019-3716225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist