Provider Demographics
NPI:1629229067
Name:WICKHAM, MELISSA NICOLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:NICOLE
Last Name:WICKHAM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:NICOLE
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2287 GREAT RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4156
Mailing Address - Country:US
Mailing Address - Phone:803-351-8937
Mailing Address - Fax:
Practice Address - Street 1:1125 W NC HIGHWAY 54 STE 503
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5718
Practice Address - Country:US
Practice Address - Phone:803-351-8937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6986225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist