Provider Demographics
NPI:1447832761
Name:LIPPASSAAR, MARISSA ALEXA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ALEXA
Last Name:LIPPASSAAR
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:ALEXA
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:199 GIBBON RD
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-3108
Mailing Address - Country:US
Mailing Address - Phone:607-337-0339
Mailing Address - Fax:
Practice Address - Street 1:19 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1418
Practice Address - Country:US
Practice Address - Phone:315-853-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024950225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility