Provider Demographics
NPI:1730460825
Name:HIMMLER, MARISA LAUREN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:LAUREN
Last Name:HIMMLER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:MARISA
Other - Middle Name:LAUREN
Other - Last Name:HARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:500 E BUSINESS WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2374
Mailing Address - Country:US
Mailing Address - Phone:513-354-3700
Mailing Address - Fax:
Practice Address - Street 1:500 E BUSINESS WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2374
Practice Address - Country:US
Practice Address - Phone:614-679-5271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT. 0028872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer