Provider Demographics
NPI:1801241617
Name:LOWERY, MARISSA (OT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:LOWERY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:DORSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3314 KNOLLS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:IJAMSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21754
Mailing Address - Country:US
Mailing Address - Phone:240-422-4364
Mailing Address - Fax:301-722-4814
Practice Address - Street 1:157 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2472
Practice Address - Country:US
Practice Address - Phone:301-722-3215
Practice Address - Fax:301-722-4814
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07407225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics