Provider Demographics
NPI:1578608626
Name:TIBBETS, MELISSA ANN (CRT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:TIBBETS
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:WIKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRT
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:NIOTAZE
Mailing Address - State:KS
Mailing Address - Zip Code:67355-0144
Mailing Address - Country:US
Mailing Address - Phone:620-673-4436
Mailing Address - Fax:
Practice Address - Street 1:139 SE KATHERINE AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2316
Practice Address - Country:US
Practice Address - Phone:918-335-6688
Practice Address - Fax:918-335-9787
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1648227800000X
KS3328227800000X
KS227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified