Provider Demographics
NPI:1083988604
Name:LUEDKE, MELISSA (OT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LUEDKE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 E LOWRY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7195
Mailing Address - Country:US
Mailing Address - Phone:720-865-6072
Mailing Address - Fax:
Practice Address - Street 1:3 SUPERIOR DR STE 225
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8661
Practice Address - Country:US
Practice Address - Phone:303-665-2603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3160225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COOTL-3160OtherSTATE LICENSE