Provider Demographics
NPI:1639641251
Name:SIEBERT, MELANIE JO (OT)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:JO
Last Name:SIEBERT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 MAST RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-9300
Mailing Address - Country:US
Mailing Address - Phone:734-717-3779
Mailing Address - Fax:
Practice Address - Street 1:5303 MAST RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-9300
Practice Address - Country:US
Practice Address - Phone:734-717-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006322225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist