Provider Demographics
NPI:1003051293
Name:BUSH, MELANIE S (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:S
Last Name:BUSH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13305-0192
Mailing Address - Country:US
Mailing Address - Phone:315-771-6657
Mailing Address - Fax:
Practice Address - Street 1:9783 RTE 126
Practice Address - Street 2:
Practice Address - City:CASTORLAND
Practice Address - State:NY
Practice Address - Zip Code:13620-0192
Practice Address - Country:US
Practice Address - Phone:315-771-6657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009909-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist