Provider Demographics
NPI:1073050357
Name:LEESON-FUCHS, MELISSA RENEE (MA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RENEE
Last Name:LEESON-FUCHS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:M
Other - Middle Name:RENEE
Other - Last Name:LEESON-FUCHS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:4800 LANCASTER PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2559
Mailing Address - Country:US
Mailing Address - Phone:302-994-4434
Mailing Address - Fax:
Practice Address - Street 1:4800 LANCASTER PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-2559
Practice Address - Country:US
Practice Address - Phone:302-994-4434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0001727225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist