Provider Demographics
NPI:1386690352
Name:BRUER, MELINDA J (OT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:J
Last Name:BRUER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:J
Other - Last Name:BRUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:225 HOLDER CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:TELLICO PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37385-5997
Mailing Address - Country:US
Mailing Address - Phone:865-309-5658
Mailing Address - Fax:423-261-2159
Practice Address - Street 1:240 W TYRONE RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6517
Practice Address - Country:US
Practice Address - Phone:865-276-3852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN197786163WG0000X
TN000339225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446652Medicaid
TN3156797OtherBCBST - GROUP NUMBER
TN5441442Medicaid
TN446652Medicare ID - Type UnspecifiedGROUP NUMBER