Active NPI
Marissa Khalifa
- Recreation Therapist
- Sterling Heights, MI
National Provider Identifier
1902498827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 82546
- Practice address
- 39393 Van Dyke Ave Ste 105
Sterling Heights, MI 48313-4636 - Phone
- (586) 722-7524
- NPI assigned
- Feb 11, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 82546 | MI | Primary |
Addresses
Primary practice location
39393 Van Dyke Ave Ste 105
Sterling Heights, MI 48313-4636
Mailing address
8366 18 Mile Rd Apt 104
Sterling HTS, MI 48313-3031
Phone (158) 658-8562
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 |
|---|---|---|---|
| 82546 | MI | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613001600000",
"number": "1902498827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8366 18 MILE RD APT 104",
"city": "STERLING HTS",
"state": "MI",
"postal_code": "483133031",
"telephone_number": "158-658-8562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39393 VAN DYKE AVE STE 105",
"city": "STERLING HEIGHTS",
"state": "MI",
"postal_code": "483134636",
"telephone_number": "586-722-7524"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHALIFA",
"first_name": "MARISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-11",
"last_updated": "2021-02-11",
"certification_date": "2021-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "MI",
"license": "82546",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sterling Heights, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.