Provider Demographics
NPI:1245663582
Name:PARKER, MARISSA D (,MSED, ATC, LAT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:D
Last Name:PARKER
Suffix:
Gender:F
Credentials:,MSED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 INWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-4840
Mailing Address - Country:US
Mailing Address - Phone:323-646-0438
Mailing Address - Fax:
Practice Address - Street 1:3002 PARKRIDGE DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-2228
Practice Address - Country:US
Practice Address - Phone:409-497-6176
Practice Address - Fax:940-497-1523
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT67972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer