Provider Demographics
NPI:1508909789
Name:AHO, MELISSA K (MSPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:AHO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 S NICOLET RD APT 2
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-7542
Mailing Address - Country:US
Mailing Address - Phone:920-730-9197
Mailing Address - Fax:
Practice Address - Street 1:1800 APPLETON RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-3727
Practice Address - Country:US
Practice Address - Phone:920-968-6234
Practice Address - Fax:920-725-2572
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10018-0242251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40384200Medicaid
WI10018-024OtherSTATE LICENSE