Provider Demographics
NPI:1659876423
Name:GILCREASE, MELANIE (OTR)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:GILCREASE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SILVER LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-5581
Mailing Address - Country:US
Mailing Address - Phone:636-667-4384
Mailing Address - Fax:
Practice Address - Street 1:905 SILVER LAKE VIEW DR
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-5581
Practice Address - Country:US
Practice Address - Phone:636-667-4384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist