Provider Demographics
NPI:1225258346
Name:WALLINGSFORD, MELISSA ANNE DAFFINSON (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE DAFFINSON
Last Name:WALLINGSFORD
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:DAFFINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL
Mailing Address - Street 1:4272 BRACKENWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138
Mailing Address - Country:US
Mailing Address - Phone:615-847-8861
Mailing Address - Fax:
Practice Address - Street 1:1927 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-904-9111
Practice Address - Fax:615-867-5223
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN853225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist