Provider Demographics
NPI:1932816931
Name:BRACKBILL, MARISSA ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ANN
Last Name:BRACKBILL
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 1:16 ELSER HILL RD
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9777
Mailing Address - Country:US
Mailing Address - Phone:717-575-7669
Mailing Address - Fax:
Practice Address - Street 1:1497 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3852
Practice Address - Country:US
Practice Address - Phone:717-430-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC018848225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist