Provider Demographics
NPI:1528593597
Name:MELLICK, ERIN BROOKE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:BROOKE
Last Name:MELLICK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 STALLION WAY
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8078
Mailing Address - Country:US
Mailing Address - Phone:614-578-2502
Mailing Address - Fax:
Practice Address - Street 1:676 STALLION WAY
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8078
Practice Address - Country:US
Practice Address - Phone:614-578-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH005066225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics