Provider Demographics
NPI:1477977494
Name:O'CULL, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:O'CULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7461 MADEIRA PINES DR
Mailing Address - Street 2:
Mailing Address - City:MADEIRA
Mailing Address - State:OH
Mailing Address - Zip Code:45243-0016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7840 THOMAS DR
Practice Address - Street 2:
Practice Address - City:MADEIRA
Practice Address - State:OH
Practice Address - Zip Code:45243-1928
Practice Address - Country:US
Practice Address - Phone:513-266-7038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT9673171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor