Provider Demographics
NPI:1275038390
Name:ROBERTS, MELISSA (OTRL)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 TOWER HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-8961
Mailing Address - Country:US
Mailing Address - Phone:989-422-5153
Mailing Address - Fax:989-422-4490
Practice Address - Street 1:2280 TOWER HILL RD
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-8961
Practice Address - Country:US
Practice Address - Phone:989-422-5153
Practice Address - Fax:989-422-4490
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1780682864OtherNPI