Provider Demographics
NPI:1710044326
Name:MACLELLAN, MELISSA JANE (OTR)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:MACLELLAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:JANE
Other - Last Name:PATRIQUIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:217 S TREMONT DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1736
Mailing Address - Country:US
Mailing Address - Phone:336-275-7026
Mailing Address - Fax:
Practice Address - Street 1:2300 SPRING GARDEN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-2135
Practice Address - Country:US
Practice Address - Phone:336-294-3338
Practice Address - Fax:336-294-6696
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4337225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127GYOtherBCBSNC
NC7301419Medicaid