Provider Demographics
NPI:1205288016
Name:HOWK, MARISSA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:HOWK
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 1:4607 WATERVIEW CT UNIT 8
Mailing Address - Street 2:
Mailing Address - City:JB ANDREWS
Mailing Address - State:MD
Mailing Address - Zip Code:20762-5351
Mailing Address - Country:US
Mailing Address - Phone:301-653-4979
Mailing Address - Fax:
Practice Address - Street 1:128 ASH ST
Practice Address - Street 2:APT 3
Practice Address - City:CALIFORNIA
Practice Address - State:PA
Practice Address - Zip Code:15419-2004
Practice Address - Country:US
Practice Address - Phone:301-653-4979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer