Provider Demographics
NPI:1114199916
Name:FELLENZ, MELISSA SUE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SUE
Last Name:FELLENZ
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 1:8586 CANYON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-8522
Mailing Address - Country:US
Mailing Address - Phone:715-944-6229
Mailing Address - Fax:
Practice Address - Street 1:104 W CUSTER AVE STE 5
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0106
Practice Address - Country:US
Practice Address - Phone:406-422-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC-8684225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics