Provider Demographics
NPI:1851734644
Name:HARRISON, MARISA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2401
Mailing Address - Country:US
Mailing Address - Phone:650-438-3809
Mailing Address - Fax:
Practice Address - Street 1:500 CANYON DR
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2401
Practice Address - Country:US
Practice Address - Phone:650-438-3809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10235225X00000X
CA12577225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist