Provider Demographics
NPI:1497308464
Name:FRANKEN, MELISSA SHANE (MS, OTR/L, CLT-LANA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SHANE
Last Name:FRANKEN
Suffix:
Gender:F
Credentials:MS, OTR/L, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 N WINTHROP AVE # 2R
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3111
Mailing Address - Country:US
Mailing Address - Phone:414-617-3645
Mailing Address - Fax:
Practice Address - Street 1:908 W ARGYLE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3894
Practice Address - Country:US
Practice Address - Phone:773-271-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009817225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist