Provider Demographics
NPI:1730466186
Name:SMALL, MARISSA BRITT (COTA/L)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:BRITT
Last Name:SMALL
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8671 SCORTON HARBOUR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6513
Mailing Address - Country:US
Mailing Address - Phone:410-360-2719
Mailing Address - Fax:
Practice Address - Street 1:310 GENESIS WAY
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-1762
Practice Address - Country:US
Practice Address - Phone:410-544-4220
Practice Address - Fax:410-647-9484
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01790224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant