Provider Demographics
NPI:1780279679
Name:STOFFEL, MARISA LEEANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:LEEANNE
Last Name:STOFFEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 PYRAMUS RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:WV
Mailing Address - Zip Code:26034-1555
Mailing Address - Country:US
Mailing Address - Phone:330-303-6797
Mailing Address - Fax:
Practice Address - Street 1:254 PYRAMUS RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:WV
Practice Address - Zip Code:26034-1555
Practice Address - Country:US
Practice Address - Phone:330-303-6797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT01830225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist