Provider Demographics
NPI:1487021523
Name:DANIELS, MELISSA (MOTR/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 PIONEER PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2947
Mailing Address - Country:US
Mailing Address - Phone:505-550-0637
Mailing Address - Fax:
Practice Address - Street 1:4415 SPANISH BROOM CT NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2557
Practice Address - Country:US
Practice Address - Phone:505-550-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3335225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist