Provider Demographics
NPI:1346263233
Name:SLADE, MELISSA VERKLER (MOT,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:VERKLER
Last Name:SLADE
Suffix:
Gender:F
Credentials:MOT,OTR/L
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:CHARLOTTE
Other - Last Name:VERKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5600 GOODMAN RD STE D
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7002
Mailing Address - Country:US
Mailing Address - Phone:662-895-4545
Mailing Address - Fax:662-895-4546
Practice Address - Street 1:5600 GOODMAN RD STE D
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-7002
Practice Address - Country:US
Practice Address - Phone:662-895-4545
Practice Address - Fax:662-895-4546
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT0574225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124616Medicaid