Provider Demographics
NPI:1073647509
Name:FELDKAMP, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:FELDKAMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 SERRAMONTE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4132
Mailing Address - Country:US
Mailing Address - Phone:650-994-4395
Mailing Address - Fax:
Practice Address - Street 1:699 SERRAMONTE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4132
Practice Address - Country:US
Practice Address - Phone:650-994-4395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1455225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist