Provider Demographics
NPI:1578753828
Name:LAIDLAW, MELINDA ANN (OT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:ANN
Last Name:LAIDLAW
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:ANN
Other - Last Name:MILLER
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24988
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0988
Mailing Address - Country:US
Mailing Address - Phone:503-443-6156
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:1315 NW 4TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1328
Practice Address - Country:US
Practice Address - Phone:541-923-7494
Practice Address - Fax:541-504-9153
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR84100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR386526Medicare PIN