Provider Demographics
NPI:1205183944
Name:CASPER, MELISSA LEE (MOTR)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:CASPER
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LEE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR
Mailing Address - Street 1:1215 E KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-4227
Mailing Address - Country:US
Mailing Address - Phone:622-751-1542
Mailing Address - Fax:
Practice Address - Street 1:1119 N WISCONSIN ST # 1209
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-1209
Practice Address - Country:US
Practice Address - Phone:262-284-5892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5224-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist