Provider Demographics
NPI:1760724793
Name:MAHAN, MARISSA HOPE
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:HOPE
Last Name:MAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 REDBUD ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5717
Mailing Address - Country:US
Mailing Address - Phone:405-831-5187
Mailing Address - Fax:
Practice Address - Street 1:220 REDBUD ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-5717
Practice Address - Country:US
Practice Address - Phone:405-831-5187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-16
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor