Provider Demographics
NPI:1477320877
Name:RICKETTS, MELANIE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:BENCHIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 N WINTER ST
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-2046
Mailing Address - Country:US
Mailing Address - Phone:937-623-8969
Mailing Address - Fax:
Practice Address - Street 1:211 N WINTER ST
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-2046
Practice Address - Country:US
Practice Address - Phone:937-623-8969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT009373225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist