Provider Demographics
NPI:1629373485
Name:PITZ, MELISSA JO (MS)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JO
Last Name:PITZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6325
Mailing Address - Country:US
Mailing Address - Phone:605-782-2368
Mailing Address - Fax:605-782-2401
Practice Address - Street 1:1100 W 41ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6325
Practice Address - Country:US
Practice Address - Phone:605-782-2368
Practice Address - Fax:605-782-2401
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0789225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist