Provider Demographics
NPI:1598941528
Name:BIRKETT, MELISSA S (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:BIRKETT
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:PO BOX 613
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-0613
Mailing Address - Country:US
Mailing Address - Phone:816-305-3469
Mailing Address - Fax:816-779-1054
Practice Address - Street 1:8306 E 235TH ST
Practice Address - Street 2:
Practice Address - City:PECULIAR
Practice Address - State:MO
Practice Address - Zip Code:64078-9267
Practice Address - Country:US
Practice Address - Phone:816-305-3469
Practice Address - Fax:816-779-1054
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004749225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist