Provider Demographics
NPI:1497051924
Name:BOHRER, MELINDA S (PT, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:S
Last Name:BOHRER
Suffix:
Gender:F
Credentials:PT, OTR/L
Other - Prefix:MS
Other - First Name:MELINDA
Other - Middle Name:S
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, OTR/L
Mailing Address - Street 1:6819 17TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6844
Mailing Address - Country:US
Mailing Address - Phone:206-525-2258
Mailing Address - Fax:
Practice Address - Street 1:6300 9TH AVE NE STE 360
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8515
Practice Address - Country:US
Practice Address - Phone:206-523-6826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003731225100000X
WAOT00000455225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist