Provider Demographics
NPI:1457593451
Name:OACHS, MARISSA M (ATC/ATR)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:M
Last Name:OACHS
Suffix:
Gender:F
Credentials:ATC/ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 E 121ST ST
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3010
Mailing Address - Country:US
Mailing Address - Phone:507-351-4770
Mailing Address - Fax:
Practice Address - Street 1:2508 E 121ST ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3010
Practice Address - Country:US
Practice Address - Phone:507-351-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer