Provider Demographics
NPI:1205553419
Name:STOLL, MARISA JUTTA
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:JUTTA
Last Name:STOLL
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 1:913 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-3343
Mailing Address - Country:US
Mailing Address - Phone:515-650-2352
Mailing Address - Fax:
Practice Address - Street 1:913 WALNUT ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-3343
Practice Address - Country:US
Practice Address - Phone:515-650-2352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007102225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist