Provider Demographics
NPI:1407187230
Name:RENNELS, MELISSA ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:RENNELS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-1460
Mailing Address - Country:US
Mailing Address - Phone:502-598-9088
Mailing Address - Fax:877-212-2525
Practice Address - Street 1:3520 SAMPLE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-7410
Practice Address - Country:US
Practice Address - Phone:502-550-2525
Practice Address - Fax:877-212-2525
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2760225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist