| NPI | 1437757549 |
|---|---|
| Former Name | MARISSA ELAINE WHITTEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 0000002444) |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2020-11-11 |