Provider Demographics
NPI:1942957899
Name:DOTSON, MARISSA JEAN
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:JEAN
Last Name:DOTSON
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 1:462 S RACCOON RD C21
Mailing Address - Street 2:462 S RACCOON RD C 21
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515
Mailing Address - Country:US
Mailing Address - Phone:330-774-4669
Mailing Address - Fax:
Practice Address - Street 1:462 S RACCOON RD C21
Practice Address - Street 2:462 S RACCOON RD C 21
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515
Practice Address - Country:US
Practice Address - Phone:330-774-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator