Provider Demographics
NPI:1437238854
Name:MARSICO, ANN LOUISE (OTR)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:LOUISE
Last Name:MARSICO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18065 RED ROCKS DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8262
Mailing Address - Country:US
Mailing Address - Phone:303-880-4273
Mailing Address - Fax:
Practice Address - Street 1:18065 RED ROCKS DR
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8262
Practice Address - Country:US
Practice Address - Phone:303-880-4273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD994792225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75987228Medicaid
CO05805325Medicaid