Active NPI
Marissa Anderson, OTR/L
- Occupational Therapist
- San Diego, CA
National Provider Identifier
1265843064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 11691
- Practice address
- 11590 W Bernardo CT Ste 100
San Diego, CA 92127-1624 - Phone
- (619) 602-3643
- NPI assigned
- May 14, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 11691 | CA | Primary |
Addresses
Primary practice location
11590 W Bernardo CT Ste 100
San Diego, CA 92127-1624
Mailing address
228 Whipple St
Oceanside, CA 92058-7789
Phone (619) 602-3643
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11691 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433203200000",
"number": "1265843064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "228 WHIPPLE ST",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "920587789",
"telephone_number": "619-602-3643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11590 W BERNARDO CT STE 100",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921271624",
"telephone_number": "619-602-3643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "MARISSA",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-05-14",
"last_updated": "2015-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "11691",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.