Provider Demographics
NPI:1275708257
Name:TAN, IRIS MELANY (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:MELANY
Last Name:TAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:IRIS MELANY
Other - Middle Name:
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:415 NE 103RD ST
Mailing Address - Street 2:APT 5E
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-3045
Mailing Address - Country:US
Mailing Address - Phone:816-590-9120
Mailing Address - Fax:
Practice Address - Street 1:415 NE 103RD ST
Practice Address - Street 2:APT 5E
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-3045
Practice Address - Country:US
Practice Address - Phone:816-590-9120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007019336225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist