Provider Demographics
NPI:1376751545
Name:LANKENAU, MELINDA SUE (OTR)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:LANKENAU
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6095 W 850 S
Mailing Address - Street 2:
Mailing Address - City:CLAYPOOL
Mailing Address - State:IN
Mailing Address - Zip Code:46510-9210
Mailing Address - Country:US
Mailing Address - Phone:574-491-6105
Mailing Address - Fax:574-491-6105
Practice Address - Street 1:1650 LYNDON FARM CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5002
Practice Address - Country:US
Practice Address - Phone:502-681-8740
Practice Address - Fax:502-213-2027
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001214A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist