Provider Demographics
NPI:1831287705
Name:RISIGO, MARC JOSEPH (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:JOSEPH
Last Name:RISIGO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FELICIA BARBER RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-2244
Mailing Address - Country:US
Mailing Address - Phone:860-861-4115
Mailing Address - Fax:
Practice Address - Street 1:8 FELICIA BARBER RD
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-2244
Practice Address - Country:US
Practice Address - Phone:860-861-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001853225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist