Provider Demographics
NPI:1912504960
Name:RAHLF, MARISSA ERIN
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ERIN
Last Name:RAHLF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25834 710TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55940-8745
Mailing Address - Country:US
Mailing Address - Phone:507-993-9597
Mailing Address - Fax:
Practice Address - Street 1:25834 710TH ST
Practice Address - Street 2:
Practice Address - City:HAYFIELD
Practice Address - State:MN
Practice Address - Zip Code:55940-8745
Practice Address - Country:US
Practice Address - Phone:507-993-9597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106353225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist