Provider Demographics
NPI:1598179368
Name:GOODY, MELISSA R (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:R
Last Name:GOODY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4380 S MONACO ST
Mailing Address - Street 2:APT 3075
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3490
Mailing Address - Country:US
Mailing Address - Phone:802-353-6781
Mailing Address - Fax:
Practice Address - Street 1:11600 W 2ND PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1527
Practice Address - Country:US
Practice Address - Phone:720-321-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072.0084711225X00000X
COOT.0003868225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist