Provider Demographics
NPI:1134887219
Name:BREITENSTEIN, MARISSA (RBT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:BREITENSTEIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WOODCROFT TRL STE D
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45430-1996
Mailing Address - Country:US
Mailing Address - Phone:937-705-6345
Mailing Address - Fax:877-739-5359
Practice Address - Street 1:7016 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45459-4300
Practice Address - Country:US
Practice Address - Phone:937-951-2084
Practice Address - Fax:877-739-5359
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-21-195118247200000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other