Provider Demographics
NPI:1235571571
Name:STEVENS, MELISSA A (OT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:STEVENS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 5629
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5629
Mailing Address - Country:US
Mailing Address - Phone:812-476-0409
Mailing Address - Fax:812-476-1016
Practice Address - Street 1:225 CROSSLAKE DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8198
Practice Address - Country:US
Practice Address - Phone:812-477-1558
Practice Address - Fax:812-474-2296
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005508A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000835902OtherBLUE CROSS BLUE SHIELD
IN000000835309OtherBLUE CROSS BLUE SHIELD
IN201189900Medicaid
IN000000835902OtherBLUE CROSS BLUE SHIELD
IN216070012Medicare PIN
IN000000835309OtherBLUE CROSS BLUE SHIELD