Provider Demographics
NPI:1043218332
Name:FORD, MELANIE A (OTD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:FORD
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E. 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114
Mailing Address - Country:US
Mailing Address - Phone:509-684-5027
Mailing Address - Fax:509-684-6133
Practice Address - Street 1:1214 N BENNETT ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-6502
Practice Address - Country:US
Practice Address - Phone:505-534-1280
Practice Address - Fax:505-534-9734
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2018-10-17
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
WAOT60061027225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM17955866Medicaid