Provider Demographics
NPI:1275731077
Name:RAFFENSPERGER, MELANIE KIM (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:KIM
Last Name:RAFFENSPERGER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:KIM
Other - Last Name:CLINGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:PO BOX 3593
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-3593
Mailing Address - Country:US
Mailing Address - Phone:406-216-5995
Mailing Address - Fax:406-216-5935
Practice Address - Street 1:2509 7TH AVE S
Practice Address - Street 2:SUITE C4
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3030
Practice Address - Country:US
Practice Address - Phone:406-216-5995
Practice Address - Fax:406-216-5935
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1019225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist