Provider Demographics
NPI:1669842282
Name:TUELL, MELISSA (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:TUELL
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ALAMO PLZ UNIT 1087
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-4062
Mailing Address - Country:US
Mailing Address - Phone:925-570-0011
Mailing Address - Fax:
Practice Address - Street 1:4101 WHISPERING OAKS LANE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506
Practice Address - Country:US
Practice Address - Phone:925-570-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-26
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12166225X00000X
VA0119007003225X00000X
CO0006463225X00000X
HI2008225X00000X
NY63-020176225X00000X
DC010001132225X00000X
ME3903225X00000X
NV15-0629225X00000X
FL17321225X00000X
WA60536791225X00000X
WY1111225X00000X
CT48-005520225X00000X
CA4196225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist