Provider Demographics
NPI:1659516565
Name:WALDREP-HENDRICKS, MELISSA RENEE (MOTR)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
Last Name:WALDREP-HENDRICKS
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:RENEE
Other - Last Name:WALDREP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2024
Practice Address - Street 1:1705 SKYLYN DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1077
Practice Address - Country:US
Practice Address - Phone:864-582-6838
Practice Address - Fax:864-585-9014
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3441225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist