Provider Demographics
NPI:1013238104
Name:WOODLEY, MARISSA NICOLE (OTA, LMT)
Entity Type:Individual
Prefix:PROF
First Name:MARISSA
Middle Name:NICOLE
Last Name:WOODLEY
Suffix:
Gender:F
Credentials:OTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MAMARONECK AVE STE 474600
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1635
Mailing Address - Country:US
Mailing Address - Phone:914-775-8519
Mailing Address - Fax:
Practice Address - Street 1:600 MAMARONECK AVE STE 474600
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1635
Practice Address - Country:US
Practice Address - Phone:914-775-8519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007611-1224Z00000X
NY021696-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant