Provider Demographics
NPI:1336464627
Name:WILLIAMSON, MELISSA JANE
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:JANE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2933 N SHERIDAN RD
Mailing Address - Street 2:APT. 215
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5965
Mailing Address - Country:US
Mailing Address - Phone:310-465-8877
Mailing Address - Fax:
Practice Address - Street 1:2933 N SHERIDAN RD
Practice Address - Street 2:APT. 215
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5965
Practice Address - Country:US
Practice Address - Phone:310-465-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008722225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist