Provider Demographics
NPI:1235610478
Name:OLTMANNS, MELISSA KAY (PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:OLTMANNS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KAY
Other - Last Name:TEMPLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1816 BROTHERS BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5301
Mailing Address - Country:US
Mailing Address - Phone:307-670-1285
Mailing Address - Fax:
Practice Address - Street 1:1816 BROTHERS BLVD APT 2
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5301
Practice Address - Country:US
Practice Address - Phone:307-670-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-26
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY0167225200000X
TX2129152225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant