Provider Demographics
NPI:1841417052
Name:ACHARON, MA. MARISSA REMOLANA (OTR/L,CLT)
Entity Type:Individual
Prefix:MS
First Name:MA. MARISSA
Middle Name:REMOLANA
Last Name:ACHARON
Suffix:
Gender:F
Credentials:OTR/L,CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IL
Mailing Address - Zip Code:62615-1177
Mailing Address - Country:US
Mailing Address - Phone:217-438-6125
Mailing Address - Fax:
Practice Address - Street 1:304 W MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IL
Practice Address - Zip Code:62615
Practice Address - Country:US
Practice Address - Phone:217-438-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2018-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16339225X00000X
MO2004014249225X00000X
IL056.007318225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist