Provider Demographics
NPI:1457899460
Name:GREENFIELD, MARISSA (COTA)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18824 110TH RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:IA
Mailing Address - Zip Code:52535-8172
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2104 12TH ST
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-2023
Practice Address - Country:US
Practice Address - Phone:712-755-5174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083629224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant