Provider Demographics
NPI:1821023128
Name:DUIVEN, MARISA LEIGH (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:LEIGH
Last Name:DUIVEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1979 JANSEN WOODS CT
Mailing Address - Street 2:
Mailing Address - City:DORR
Mailing Address - State:MI
Mailing Address - Zip Code:49323-9452
Mailing Address - Country:US
Mailing Address - Phone:616-970-4306
Mailing Address - Fax:
Practice Address - Street 1:3491 M40
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MI
Practice Address - Zip Code:49419
Practice Address - Country:US
Practice Address - Phone:369-751-2150
Practice Address - Fax:269-751-2140
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202004693224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant