Provider Demographics
NPI:1649877739
Name:FRIDAY, MARISSA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:FRIDAY
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 1:3860 DOBIE RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3704
Mailing Address - Country:US
Mailing Address - Phone:559-784-7375
Mailing Address - Fax:
Practice Address - Street 1:3860 DOBIE RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3704
Practice Address - Country:US
Practice Address - Phone:517-381-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440586225X00000X
MI5201011001225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist