Provider Demographics
NPI:1437295748
Name:FITZGERALD, MELISSA JANE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JANE
Last Name:FITZGERALD
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 1:2092 IGLEHART AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5044
Mailing Address - Country:US
Mailing Address - Phone:651-641-1228
Mailing Address - Fax:
Practice Address - Street 1:1710 SUBURBAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-6636
Practice Address - Country:US
Practice Address - Phone:651-254-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100564225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist